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Childhood Sexual Abuse and Fear of Abandonment Moderate the Relation of Intimate Partner Violence to Severity of Dissociation
Abstract
Betrayal trauma theory proposes a relation between intimate partner violence (IPV) and dissociation, suggesting that dissociation among victims of IPV may function to restrict awareness of abuse in order to preserve attachments perceived as vital. We investigated two factors that may moderate the relation between IPV and dissociation-childhood sexual abuse (CSA) severity and fear of abandonment-among 348 women currently in a relationship. The relation between frequency of IPV (sexual and physical) and dissociation (amnesia and depersonalization) was moderated by CSA severity and fear of abandonment. Specifically, among women with clinically-relevant fear of abandonment, the strength of the relation between IPV and dissociation became stronger as CSA severity increased. This study is the first to demonstrate the moderating roles of fear of abandonment and CSA history in the relation between IPV and dissociation among women. Findings suggest that it may be important to target fear of abandonment in interventions with IPV victims who have a CSA history. Results suggest that fear of abandonment warrants greater attention in research on IPV revictimization.
... De ce fait les rapports intimes réactivent non seulement les scènes traumatiques, mais les reconnectent aussi un autre soi, celui qui fut abusé et agressé à l'époque du traumatisme. Pas étonnant alors que le vécu de l'intimité sexuelle, y compris avec un être aimé, devienne éprouvant (Zerubavel et al., 2018). ...
... De la même manière, la gravité des traumatismes sexuels influence les dysfonctionnements et la satisfaction sexuelle par le biais de relations intimes de moins bonne qualité, de complications dans les communications avec le partenaire, d'une réduction du plaisir sexuel ou encore d'une perception plus grande des douleurs lors des rapports DiMauro et Renshaw, 2019 ;Neilson et al., 2017). Une autre étude met en avant que des antécédents d'abus sexuels durant l'enfance considérés de modéré à sévère augmentent les niveaux de dissociation chez les femmes victimes de violence conjugale, en particulier lorsqu'elles ressentent une peur de l'abandon (Zerubavel et al., 2018). La dissociation peut permettre aux victimes d'une telle violence de se cloisonner ou se détacher des expériences douloureuses avec le partenaire, protégeant ainsi les liens d'attachement dans la relation. ...
... Dans le cas des abus intrafamiliaux, cette impuissance peut s'exprimer par l'impossibilité de changer de famille, pourtant tout aussi dysfonctionnelle soit-elle. Zerubavel et al. (2018) font référence à la trahison dans le traumatisme. Effectivement, les victimes peuvent se sentir trahis par l'agresseur si elle le connaissait, mais aussi par ceux qui, par négligence ou complicité ne sont pas intervenus pour faire cesser les violences. ...
Résumé
Objectif
Cette revue systématique de la littérature a pour objectif de synthétiser les différentes études mettant en lien les traumatismes sexuels et leurs conséquences sur la sexualité des victimes. L’objectif principal étant de dégager les spécificités des traumatismes sexuels au regard de leurs répercussions sur la santé sexuelle.
Méthode
Une revue systématique de la littérature a été réalisée à partir des recommandations PRISMA grâce aux mots-clés suivants : Sexual Abuse, Sexual Trauma, Sexual Violence, Sexual Assault, Rape and PTSD, Post Traumatic Stress Disorder, Trauma dans les bases de données PubMed, TaylorAndFrancis ainsi que ScienceDirect.
Résultat
Au total, 19 articles ont été retenus. Bien que les études varient fortement au niveau méthodologique, elles mettent en évidence un fonctionnement sexuel altéré ainsi qu’une faible satisfaction dans les rapports intimes après un traumatisme de nature sexuel. Des répercussions psychologiques, somatiques et comportementales sont à signaler car elles viennent directement impacter les processus psychobiologiques à l’origine d’une santé sexuelle satisfaisante. Enfin, plusieurs facteurs sont identifiés comme semblant intervenir et moduler les conséquences de ce type d’événement sur la sexualité.
Conclusion
La victimisation sexuelle relève de spécificités incomparables par nature avec d’autres types d’événements traumatiques au regard de la gravité de ses conséquences délétères sur la vie quotidienne des patients. Ainsi, il convient d’élargir la question du psychotraumatisme à d’autres considérations que la seule symptomatologie du trouble de stress post traumatique (TSPT). En effet, les résultats obtenus semblent indiquer que certains troubles sexuels peuvent être appréhendés comme des conséquences somatoformes d’une réponse psychotraumatique consécutive aux traumatismes sexuels vécus dans le passé. Si les troubles sexuels n’ont bien entendu pas tous une origine psychotraumatique, cette derrière piste mérite néanmoins d’être considérée par les sexologues comme une facteur étiologique à envisager.
... Such insecurity may present itself as abandonment concerns, marked by a vision of oneself as being inferior to others, a tendency to "sacrifice" oneself for the maintenance of interpersonal relationships, a deep-rooted fear of being abandoned or rejected by one's partner, and a great desire for emotional closeness leading to less discrimination in the choice of intimate partners (Mikulincer & Shaver, 2018). Among samples of women, associations have been demonstrated between CSA experience, abandonment concerns, and IPV revictimization (Zerubavel et al., 2018). The present study illustrates this phenomenon using the perspective of women survivors of their own relational experiences. ...
A metasynthesis was performed on 15 qualitative studies to document the experience of revictimization by an intimate partner among women, based on survivors’ perspectives on their sustained childhood sexual abuse and intimate partner violence victimization. Results identified two main conceptual categories: (a) Barriers to action: A belief system reflecting learned helplessness that hinders women’s abilities to protect themselves and prevent further abuses, and (b) Broken internal compass: Cognitive elements blurring women’s risk evaluation capacities and reference points limiting their ability to break the cycle of revictimization. These findings support the need to examine cognitive distortions and false beliefs in intervention practices and suggest valuable guidelines for practitioners. As the responsibility for violence always lies with the perpetrator, this study should not be interpreted as blaming women for their victimization, but instead, as a way to give women a voice about their experiences and give them a sense of power in the prevention of violence.
... Ce biais de perception, qui comprend un état dissocié, constitue donc un facteur de risque de revictimisation. Par exemple, plusieurs études ont montré que les SPI du domaine « Séparation et rejet » (facteurs de risque proximaux) contribuent à être victime de violences conjugales ultérieurement, alors que les maltraitances durant l'enfance (facteurs de risques distaux) y participent de manière indirecte, par la médiation de ces SPI (Gay et al., 2013;Zerubavel et al., 2018). Chez les victimes de violences conjugales, la dissociation peut notamment avoir pour fonction de restreindre la conscience de l'abus afin de préserver les attachements perçus comme vitaux. ...
Ce projet de thèse vise à étudier la pertinence d’utiliser la médiation équine en thérapie, auprès de personnes ayant des troubles addictifs. Dans un premier temps, il s’agira d’étudier l’influence du style d’attachement des patients sur leur niveau d’autonomie ; en s’appuyant sur des modèles théoriques tels que la théorie de l’attachement (Bowlby, 1969-82 ; Hazan, 1987) et la théorie de la motivation autonome (Decy et Ryan, 2000). Dans un deuxième temps, l’objectif sera d’explorer, de décrire et d’évaluer les processus à l’œuvre durant l’intervention à visée thérapeutique avec le cheval. Cette recherche s’inscrit dans le cadre de la compréhension et de l’évaluation des interventions complexes, axe fort de recherche du laboratoire APEMAC. Le questionnement principal de ce projet de thèse est d'interroger la place de la théorie de l’attachement dans les interventions en psychologie de la santé, notamment dans les programmes de prévention de la reconsommation et de la rechute. Quels liens la motivation et l’attachement entretiennent-ils ? En quoi les troubles de l’attachement peuvent-ils entraver le processus de guérison et la tenue de l’abstinence chez ces patients ? L’utilisation du cheval en thérapie peut-elle permettre d’augmenter le sentiment de sécurité interne des personnes et favoriser le développement de leurs compétences d’auto-régulation et de la motivation autonome ? En somme, peut-on augmenter l’autonomie des patients en leur proposant une intervention qui cible les troubles de l’attachement ? Le recueil des données sera réalisé au Centre de Soins de Suite et de Réadaptation en Addictologie « la Fontenelle ». Tout au long de cette recherche, nous prévoyons d’effectuer différentes évaluations quantitatives à l’aide d’outils psychométriques. Nous utiliserons également des méthodes qualitatives en réalisant des entretiens cliniques.
... In the current study, dissociation was not associated with either sexual revictimization or psychological dating violence. Individuals with dissociative symptoms may feel emotionally numb, distant from their surroundings and forget certain events which could lead them to misidentify acts of sexual (Gewirtz-Meydan & Lahav, 2020), and psychological dating violence (Zerubavel et al., 2017). Physical marks of abuse (ex. ...
Interpersonal revictimization, through sexual violence and psychological or physical dating violence, is one of the many consequences of childhood sexual abuse (CSA). This study examined how childhood maltreatment, sociodemographic characteristics, mental health, relational factors, and community factors are associated with 1) sexual revictimization 2) psychological dating violence victimization, and 3) physical dating violence victimization in a sample of young adults reporting a history of CSA. A sample of 190 young adults (18–25 y.o.) with self-reported experiences of CSA completed an online survey measuring childhood maltreatment (e.g. neglect, physical abuse, witness to domestic violence), sociodemographic characteristics (e.g. material deprivation, education), mental health (dissociation, posttraumatic stress symptoms), relational factors (e.g. insecure attachment style), and community factors (e.g. neighborhood disadvantage). Hierarchical logistic regressions indicated that once all risk factors were entered in the models, PTSD was positively associated with psychological dating violence, while dissociation was positively associated with physical dating violence. Physical abuse in childhood was positively associated with sexual revictimization. The present study shows the importance of simultaneously considering the impact of multiple characteristics surrounding CSA survivors when evaluating risks of revictimization. Additionally, it highlights the importance of providing CSA survivors with adequate mental health support for trauma-related disorders, as it may be crucial to prevent revictimization.
... Association studies generally focused on genes related to a limited number of neural or neuroendocrine pathways, many of which are non-specifically associated with a wide range of psychiatric disorders [96,97]. In gene-environment designs, only specific forms of environmental risk, such as childhood abuse by parents or caregivers, were assessed; other relevant forms of traumatic stress, such as bullying by peers, intimate partner violence, or sexual assault after adolescence, were not investigated despite their relevance to dissociation [98][99][100]. In studies measuring dissociative symptoms, there was significant heterogeneity in the instruments used to measure symptom severity, as well as in the specific type(s) of symptoms being studied; in some cases, data on different dimensions of dissociation in relation to the genotype was not analyzed, despite being available. ...
Dissociative disorders are a common and frequently undiagnosed group of psychiatric disorders, characterized by disruptions in the normal integration of awareness, personality, emotion and behavior. The available evidence suggests that these disorders arise from an interaction between genetic vulnerability and stress, particularly traumatic stress, but the attention paid to the underlying genetic diatheses has been sparse. In this paper, the existing literature on the molecular genetics of dissociative disorders, as well as of clinically significant dissociative symptoms not reaching the threshold of a disorder, is reviewed comprehensively across clinical and non-clinical samples. Association studies suggest a link between dissociative symptoms and genes related to serotonergic, dopaminergic and peptidergic transmission, neural plasticity and cortisol receptor sensitivity, particularly following exposure to childhood trauma. Genome-wide association studies have identified loci of interest related to second messenger signaling and synaptic integration. Though these findings are inconsistent, they suggest biologically plausible mechanisms through which traumatic stress can lead to pathological dissociation. However, methodological concerns related to phenotype definition, study power, and correction for the confounding factors limit the value of these findings, and they require replication and extension in studies with better design.
... Individuals who are resilient are less likely to experience negative psychological outcomes after failure experiences than individuals who are not resilient (Southwick et al., 2005) It is suggested that if individuals experience multiple failures but are highly resilient, they may not be at high risk for depression or anxiety because they can bounce back from a negative experience (Herrman et al., 2011). Second, literature suggests that failure experiences can cause individuals to develop a sense of fear of failing (Castella et al., 2013).While there are some studies regarding loss and trauma that have examined variations of how resilience and fear moderate certain outcomes (e.g., Ogi nska-Bulik & Kobylarczyk, 2017;Zerubavel et al., 2018), little research to date has attempted to explain their respective role as a potential mediator for both positive and negative outcomes of experiencing academic failure. ...
Failure experiences often lead to maladaptive outcomes, such as depression; however, in some instances, these same failure experiences yield positive outcomes such as wisdom. This study examines the mediational processes that may explain why an individual experiences these positive or negative outcomes following academic failure. Results from the online study (n = 208) found that the relationship between academic failure and depression is sequentially mediated by resiliency and fear of failure, and the relationship between failure and wisdom is mediated by fear of failure. These results can be used to create resources that help foster more positive outcomes when facing failure.
... As suggested by the American Psychiatric Association (2013), such characteristics, along with dissociation processes, could lead to underestimate gaslighting behaviours from one's partner and impair the ability to identify an abusive relationship. The existing literature points to the fact that individuals with low levels of mentalisation (Ensink et al., 2017) and high levels of dissociation (Zerubavel et al., 2017) quite often find it difficult to protect themselves and end a dysfunctional relationship. Previous studies have also established an association between poor mentalising skills and vulnerability to abusive relationships (Asen & Fonagy, 2017;Pallini et al., 2017). ...
This study focused on gaslighting, a specific type of psychological violence occurring in intimate relationships, where one partner displays controlling behaviours towards the other. The aim of the research was to analyse the association between gaslighting behaviours and dysfunctional personality domains of both abusers and survivors, respectively assessed through the PID-5-IRF and the PID-5-BF. A group of 250 young adults (males = 124), aged 18–30 years (M = 22.99, SD = 3.02), took part in this study. Our results showed that (a) for abusers, detachment, disinhibition and psychoticism were positively associated with gaslighting behaviours, and (b) for survivors, antagonism, disinhibition and psychoticism were positively associated with gaslighting behaviours from a partner.
... Conforme se verifica, assim como na violência presencial entre parceiros íntimos (Barros et al., 2016;Zerubavel, Messman-Moore, DiLillo, & Gratz, 2018), o medo e a insegurança são impostos às vítimas de ADRA. Tais elementos são preocupantes uma vez que podem ser responsáveis pela emergência de sofrimento relacional refletidos em danos psicológicos e de insatisfação conjugal. ...
The present study aimed at apprehending the social representations (SR) of Brazilian university students about digital Cyber Dating Abuse (CDA). A total of 447 participants participated in the study, responding to the Free Word Association Technique and the Cyber Dating Abuse Questionnaire (CDAQ). The data pointed to a high prevalence of involvement in CDA, both in victimization (87.6% control / monitoring, 34.7%, direct aggression); (92.6% control/monitoring, 25.1%, direct aggression). In addition, the results indicated that the structuring elements of SR were anchored in contemporary relational uncertainty and the conception of dominance within intimate relationships. Concerning the evocations of the peripheral nucleus, CDA was anchored in the violation of the rights to privacy and its causes and consequences, permeating psycho-affective and social aspects. Finally, the data revealed that "jealousy" presents itself as the central and organizing element of RS of this phenomenon, motivating abusive virtual actions.
The aim of the study is to examine the mediating role of borderline personality pattern and separation anxiety in adults in the relationship between childhood traumas and exposure to abuse in romantic relationships, to emphasize some factors that may cause violence in relationships, and to support initiatives to prevent exposure to partner violence. For the research 400 participants aged 18-55 residing in Istanbul determined by simple random sampling method. After than Socio-demographic Information Form, Childhood Traumas Questionnaire (CTQ-33), Romantic Relationship Assessment Inventory (RRAI), Borderline Personality Questionnaire (BPQ), Adult Separation Anxiety Questionnaire (ASAQ) were given to them. The data obtained from the study were evaluated with the SPSS-25 statistical analysis program. Relationships between scales were evaluated with Pearson Correlation analysis and mediating roles were evaluated with PROCESS 3.5 Macro. All analyzes were based on a 95% confidence interval. When the research findings are examined, Childhood Traumas Questionnaireand all its subscales and Borderline Personality Disorder Scale and all its subscales; A positive correlation was found between the Adult Separation Anxiety Questionnaire and the Romantic Relationship Assessment Scale. Similarly, a positive correlation was also found between the Borderline Personality Questionnaire and all its subscales, and the Adult Separation Anxiety Questionnaire and the Romantic Relationship Assessment Scale. In addition, the results of the research show that the Childhood Traumas Questionnairepredicts the Romantic Relationship Assessment Inventory and that Borderline Personality Traits and Adult Separation Anxiety play a partial mediating role in this relationship. As conclusion, it was determined that childhood abuse and neglect experiences were associated with unhealthy personality patterns and exposure to maltreatment in adulthood romantic relationships.
Bu araştırma, bireylerin cinsel istismara maruz kalmış kişilere ilişkin bakış açılarını anlamak ve cinsel istismara maruz kaldığı varsayılan yakınına ve partnerine karşı yaklaşımlarını incelemek amacıyla yapılmıştır. Çalışma, nitel araştırma yöntemiyle gerçekleştirilmiş olup araştırma modeli olarak olgu bilim deseni kullanılmıştır. Araştırmanın çalışma grubu 17 ile 56 yaş aralığında bulunan 274'ü kadın, 208'i erkek olmak üzere toplam 482 katılımcıdan oluşmaktadır. Araştırmada 129 veri yüz yüze görüşme ile toplanmışken, 203 veri online olarak toplanmıştır. Veriler analiz edilirken içerik analizi yöntemi kullanılmış ve yanıtlar temalar halinde kategorilere ayrılmıştır. Araştırma sonucunda bireylerin cinsel istismara maruz kalmış kişilere ilişkin algılarının cinsiyet ve medeni durum değişkenlerine göre farklılaştığı, kendi partnerlerinin ve yakınlarının cinsel istismara uğramış olması halinde ise onlara karşı duyarlı, kabullenici, destekleyici ve daha az reddedici bir tutum içinde oldukları görülmüştür. Ayrıca katılımcıların cinsel istismar mağdurlarına ilişkin görüşleri, temel noktalar açısından benzer olsa da alt temalar açısından çeşitlilik göstermektedir.
Objective:
Female survivors of intimate partner violence have greater risk for contracting HIV/STI's and experiencing dissociation. However, no studies have examined the association between dissociation and condom use self-efficacy in this population. This study explored whether dissociation during sex was negatively associated with condom use self-efficacy.
Methods:
Thirty-five women (88% African American) who were residing in domestic violence shelters in the United States completed questionnaires.
Results:
There was a negative correlation between dissociative experiences during sex and condom use self-efficacy, r = -.62, n=35, p< .01.
Conclusions:
Findings suggest that dissociation during sex interferes with abused women's condom use self-efficacy.
Background:
Intimate partner violence (IPV) victimization is a serious public health problem in the world. It is imperative to examine risk factors for IPV victimization.
Objective:
This meta-analysis aimed to explore the relationship between childhood maltreatment (CM) and IPV victimization and investigate the moderating effects of gender and marital status.
Participants and setting:
Examination of the literature produced a sample of 56 effect sizes (N = 23,127) for review.
Methods:
PsycINFO, PsycArticles, EBSCO-ERIC, Medline, Google Scholar, and ProQuest Dissertations & Theses databases were systematically searched until March 31, 2018. Forty-six eligible studies were included in the meta-analysis. Random effects model was used for meta-analysis of the studies.
Results:
Results indicated a significant association between total CM and IPV victimization (r = .18, p < .001). Further subgroup analyses revealed that all four types of CM (childhood physical abuse, psychological abuse, sexual abuse, and neglect) were positively related to IPV victimization (r = .19, .18, .17, and .12, respectively). Moreover, the moderation analyses revealed that the association between CM and IPV victimization was stronger for dating couples than for married ones. However, this relation did not show significant difference between males and females.
Conclusions:
There is an association between CM and IPV victimization, and it is moderated by marital status.
Previous research suggests that studying the effect of dissociation is particularly important in survivors of intimate partner violence (IPV) due to risk of revictimization. The current study investigated demographic variables, child and current abuse characteristics, coping style, and cognitive distortions as predictors of peritraumatic, trait, and PTSD-related dissociation in a sample of female IPV survivors. The sample consisted of 372 women, majority African-American, with an average age of 34.41 years (SD = 8.09). Peritraumatic dissociation was significantly predicted by child physical abuse, current abuse injury, cognitive distortions about safety, and problem disengagement coping. Trait dissociation was significantly predicted by minority race, personal income, and cognitive distortions about safety and self-worth. PTSD-related dissociation was significantly predicted by cognitive distortions about self-worth, problem and emotion disengagement coping, and peritraumatic dissociation. In the models predicting both trait and PTSD-related dissociation, abuse characteristics significantly predicted dissociation until the entry of cognitive variables into the model. Analysis indicated a significant indirect effect of cognitive distortions on the relationship between current sexual aggression and trait dissociation. Results also suggested that there were indirect effects of both cognitive distortions and peritraumatic dissociation on the relationships between current psychological abuse/injury and PTSD-related dissociation. Findings point to the importance of cognitions in the development and maintenance of dissociation, and suggest that treatments designed to help clients accept and process traumatic events may help reduce dissociation, and in turn prevent future revictimization.
A college freshman reports a sexual assault and is met with harassment and insensitive investigative practices leading to her suicide. Former grade school students, now grown, come forward to report childhood abuse perpetrated by clergy, coaches, and teachers-first in trickles and then in waves, exposing multiple perpetrators with decades of unfettered access to victims. Members of the armed services elect to stay quiet about sexual harassment and assault during their military service or risk their careers by speaking up. A Jewish academic struggles to find a name for the systematic destruction of his people in Nazi Germany during the Holocaust. These seemingly disparate experiences have in common trusted and powerful institutions (schools, churches, military, government) acting in ways that visit harm upon those dependent on them for safety and well-being. This is institutional betrayal. The purpose of this article is to describe psychological research that examines the role of institutions in traumatic experiences and psychological distress following these experiences. We demonstrate the ways in which institutional betrayal has been left unseen by both the individuals being betrayed as well as the field of psychology and introduce means by which to identify and address this betrayal. (PsycINFO Database Record (c) 2014 APA, all rights reserved).
Dissociation involves retreating from the experience of the present moment through various processes, while mindfulness cultivates the ability to stay in the present moment. We argue that mindfulness is thus uniquely well suited for treatment of dissociation. This paper delineates the theoretical relationship between mindfulness and dissociation, discussing how incorporating mindfulness into psychotherapy can improve outcomes for dissociative clients. Mindfulness can provide clients with specific techniques for enhancing prediction of and control over dissociation through building awareness of dissociative processes and offering a tool for staying in the present moment. Mindfulness reduces reliance on avoidance, which in turn diminishes the need for dissociation. In addition, taking the position of the observer, which is a key feature of mindfulness, is itself a capability associated with dissociation. We discuss the application of mindfulness to three types of dissociative processes: detachment (e.g., depersonalization, derealization), absorption (e.g., day-dreaming, “blanking out”), and compartmentalization (e.g., amnesia, conversion symptoms). Three mechanisms underlying the effectiveness of integrating mindfulness into treatment of dissociation are proposed: 1) the techniques of mindfulness (e.g., observing, staying present), 2) the metacognitions of mindfulness (e.g., acceptance, nonjudgment), and 3) the emergent processes of mindfulness (e.g., reperceiving, dialectical thinking). Challenges to implementation of mindfulness with dissociative clients are also explored. Information and recommendations are provided to guide applications to intervention.
Betrayal trauma theory (Freyd, 1994, 1996, 2001) is an approach to conceptualising trauma that points to the importance of social relationships in understanding post-traumatic outcomes, including reduced recall. We argue in this paper that child sexual abuse very often constitutes a severe betrayal trauma and that it is thus “genuinely traumatic”. We will also argue that one reasonably common effect of child sexual abuse—particularly the more it involves betrayal trauma—is some degree of forgetting or “knowledge isolation” about the event. This last claim speaks to the heart of betrayal trauma theory that McNally has summarised and critiqued. In this paper we will respond to aspects of McNally's critique as well as offer our own perspective on the state of betrayal trauma theory. We discuss (1) conceptual issues, (2) critiques of empirical studies, and (3) future directions. Although our interpretation of data diverges from McNally's in many places, we have all arrived at a surprisingly common endpoint. McNally suggests a child may not think about the abuse for several reasons, such as fears that disclosure may break up the family. In accord with betrayal trauma theory, we note that the failure to think about events will contribute to poorer memory for the event and that these processes are mediated by the unique demands placed on a child exposed to betrayal traumas.
This study examined the relationship between sexual revictimization and interpersonal problems in a sample of adult survivors of childhood sexual abuse diagnosed with post-traumatic stress disorder. Fifty-two treatment-seeking women participated in this study. Research participants completed the Sexual Experiences Survey to assess sexual revictimization within the past 6 months and completed the Inventory of Interpersonal Problems (IIP). Revictimized participants reported overall greater interpersonal problems compared with nonrevictimized participants. Post hoc analyses showed significantly higher interpersonal problem scores for revictimized participants on the Hard to Be Assertive and Too Responsible subscales. On the circumplex IIP, revictimized participants were more socially avoidant, nonassertive, and overly nurturant.
in Undetermined The International Society for the Study of Dissociation (ISSD), the former name of the International Society for the Study of Trauma and Dissociation (ISSTD), adopted the Guidelines for Treating Dissociative Identity Disorder (Multiple Personality Disorder) in Adults in 1994. However, the Guidelines must be responsive to developments in the field and require ongoing review. The first revision of the Guidelines was proposed by the ISSD’s Standards of Practice Committee1 and was adopted by the ISSD Executive Council in 1997 after substantial comment from the ISSD membership. The second revision of the Guidelines was requested and approved in 2005 based on the expertise of a task force of expert clinicians and researchers.2 The current revision was undertaken by a new task force3 in 2009 and 2010 after input from an open-ended survey of the membership. The current revision of the Guidelines focuses specifically on the treatment of dissociative identity disorder (DID) and those forms of disso- ciative disorder not otherwise specified (DDNOS) that are similar to DID. It is intended as a practical guide to the management of adult patients and represents a synthesis of current scientific knowledge and informed clinical practice. There is a separate Guidelines for the Evaluation and Treatment of Dissociative Symptoms in Children and Adolescents (ISSD, 2004) available through the ISSTD and published in the Journal of Trauma & Dissociation. The American Psychiatric Association (2004) has published Practice Guidelines for the Treatment of Patients with Acute Stress Disorder (ASD) and Posttraumatic Stress Disorder (PTSD), which may be relevant to the treatment of DID. (Less)
Exposure to chronic interpersonal violence (IPV) has been associated with psychiatric impairment; however, few studies have investigated attention processes and psychophysiology in this population.
We investigated self-report and physiological correlates of attention biases in 27 IPV-exposed women.
Participants completed self-report measures of trauma history, posttraumatic stress disorder (PTSD) symptoms, and dissociation; were monitored physiologically during baseline; and responded to an emotional dot probe task.
Participants showed bias away from positive and anxiety words, and toward IPV words. Lower baseline respiratory sinus arrhythmia (RSA) and higher skin conductance levels were associated with bias away from anxiety cues. Greater total PTSD symptoms were associated with bias toward IPV cues, and greater PTSD intrusion and avoidance symptoms were associated with lower RSA. Individuals exposed to more types of trauma had lower heart rates.
These data extend the research on emotion-cognition interactions in PTSD and other anxiety disorders to chronic IPV survivors, in part confirming avoidance and intrusion symptom and attention bias relations found in studies. The present work also draws attention to a group that tends to experience a range of severe symptoms associated with apparent blunting in autonomic activity, and suggests that self-report may not be sensitive to physiological and attention alterations in chronic IPV samples.
Psychological distress and coping strategies following intimate partner violence (IPV) victimization may impact survivors' risk for future IPV. The current study prospectively examined the impact of distinct posttraumatic stress disorder (PTSD) symptom clusters (reexperiencing, avoidance, numbing, and hyperarousal), dissociation, and coping strategies (engagement and disengagement coping) on IPV revictimization among recently abused women. Women (N = 69) who were seeking services for IPV and experienced their most recent episode of physical IPV between 2 weeks and 6 months prior to study enrollment completed measures of physical IPV, psychological distress, and coping strategies at baseline and at 6-month follow-up. The women averaged 36 years of age and 67% of the sample was African American. Separate Poisson regression analyses revealed that PTSD hyperarousal symptoms, dissociation, engagement coping, and disengagement coping each significantly predicted physical IPV revictimization at the 6-month follow-up (with effect sizes ranging from a 1.20-1.34 increase in the likelihood of Time 2 physical IPV with a 1 SD increase in the predictor). When these significant predictors were examined together in a single Poisson regression model, only engagement and disengagement coping were found to predict physical IPV revictimization such that disengagement coping was associated with higher revictimization risk (1.29 increase in the likelihood of Time 2 physical IPV with one SD increase in disengagement coping) and engagement coping was associated with lower revictimization risk (1.30 decrease in the likelihood of Time 2 physical IPV with one SD increase in engagement coping). The current findings suggest that coping strategies are important and potentially malleable predictors of physical IPV revictimization.
Identifying the factors that contribute to ongoing intimate partner abuse (IPA) among survivors of childhood abuse is essential to developing appropriate interventions. The current study assessed prospectively whether childhood betrayal trauma (BT) history and women’s potential dependence on their perpetrators (unemployment, number of children below 13) increased women’s risk of ongoing victimization, while controlling for trauma-related symptoms (PTSD, depression, dissociation). Women survivors of IPA (N = 190) from an urban U.S. city were recruited based on an IPA incident reported to the police. At the initial interview, women reported on childhood betrayal trauma experiences, their employment status, number of children, and current trauma-related symptoms. Women returned 6 months later and reported on ongoing events of victimization (physical, sexual, psychological aggression, and injury) in their relationships with the initial IPA perpetrator. Results showed that higher levels of childhood BT were associated with ongoing victimization over the course of 6 months. Women’s unemployment status predicted greater physical and sexual aggression and injuries. Higher levels of depression and lower levels of PTSD symptoms were also associated with increases in physical, sexual, and psychological aggression, and bodily injury. The findings have important implications for interventions by demonstrating the need to process women’s betrayal trauma experiences, target depression symptoms, and increase women’s economic opportunities to prevent further victimization.
This study's purpose was to compare childhood trauma histories, family-of-origin characteristics, affect dysregulation, and attachment characteristics of 93 battered women abused in either single (44%) or multiple (56%) relationships in adulthood. Research participants were administered the Adult Attachment Interview (M. Main & R. Goldwyn, 1998) and completed self-report measures. Multiply victimized women were significantly more likely to have been sexually abused in childhood, to have witnessed violence, and to have experienced parent–child role reversal. Affect dysregulation differentiated the 2 groups but did not mediate the effect of childhood trauma. Women who were unresolved in their attachment were more likely to be multiply victimized in adulthood. Different pathways may lead from women's childhood trauma to vulnerability for multiple victimization in adulthood. (PsycINFO Database Record (c) 2012 APA, all rights reserved)
Inspired by work with a private client, I began a research project aimed at investigating the psychological development of victim self-states, not just as a product of interpersonal trauma but in the broader context of cultural demands for women to dissociate feelings that have been labeled antithetical to accepted gender norms for heterosexual behavior. As part of the Emotional Empowerment Project, I interviewed women who had been in long-term relationships characterized by verbal and emotional abuse as well as serious physical violence. Using a psychoanalytically oriented interview format, I collected more than 24 hours of narrative about the women's experiences. The analysis led me to hypothesize significant links among experiences of child abuse, the absence of gender-dystonic emotions along an aggressive continuum, masochistic self-states in adulthood, and the surrender of agency during intimate relationships. The work brings up important questions regarding the intersection of psychoanalytic psychotherapy and society, such as whether the integration of dissociated aggression would be facilitated by the incorporation of techniques aimed at raising consciousness around gender inequities, and whether it is incumbent on therapists treating battered women to confront more systematically their own participation in systems of oppression, as those attitudes insinuate themselves in the countertransference. (PsycINFO Database Record (c) 2012 APA, all rights reserved)
At its meeting in Vancouver, BC, Canada, in May 1994, the Execu-tive Council of International Society for the Study of Dissociation (ISSD) adopted the Guidelines for Treating Dissociative Identity Disor-der (Multiple Personality Disorder) in Adults (1994). The Guidelines presented a broad outline of what to date was considered to be effective treatment for Dissociative Identity Disorder (DID). However, Guide-lines like these are never finished and require ongoing revisions. A first revision of the Guidelines was proposed by the ISSD's Standards of Practice Committee 1 and was adopted by the ISSD Executive Council in 1997 after substantial comment from the ISSD membership and sev- for the Study of Dissociation. The Guidelines may be reproduced without the written permission of the International So-ciety for the Study of Dissociation (ISSD) as long as this copyright notice is included and the address of the ISSD is included with the copy. Violations are subject to prose-cution under federal copyright laws. Additional copies of the guidelines (US 10 for nonmembers) can be obtained by writing to the ISSD at 60 Revere Dr., Suite 500, Northbrook, IL 60062 USA. The correct citation for this revision of the Guidelines is: International Society for the Study of Dissociation. (2005). This electronic prepublication version may contain typographical errors and may be miss-ing artwork such as charts, photographs, etc. Pagination in later versions may differ from this copy; citation references to this material may be incorrect when this prepublication edition is replaced at a later date with the finalized version. eral revisions. This current revision was requested and approved by the ISSD Executive Council, and utilized the expertise of a Task Force of expert clinicians and researchers. 2 These Guidelines are not intended to replace clinical judgment. How-ever, they summarize expert consensus concerning safe and effective treatment for DID patients. Where a clear divergence of opinion exists in the field, the Guidelines attempt to present the different points of view about the issue. The Guidelines strive to be as free as possible of bias toward any theoretical approach to treatment. These Guidelines focus specifically on the treatment of DID. They are a practical guide to the management of patients-primarily adults over the age of 18-and represent a synthesis of current scientific knowl-edge and rational clinical practice. However, DID is only one of the dissociative disorders. There continues to be a need to explore the phe-nomenology and treatment of other forms of pathological dissociation (e.g., Depersonalization Disorder, Dissociative Amnesia, etc.) as well as non-pathological forms of dissociation (e.g., the relation of trance states to dissociation). However, principles of treatment of DID may also be applicable to some extent in the treatment of other dissociative disorders. There are now separate Guidelines for the Evaluation and Treatment of Dissociative Symptoms in Children and Adolescents (International Society for the Study of Dissociation [ISSD], 2004), available through the ISSD and published in the Journal of Trauma & Dissociation, 5(3), 119-150. The American Psychiatric Association has published Practice Guidelines for the Treatment of Patients with Acute Stress Disorder (ASD) and Posttraumatic Stress Disorder (PTSD) (American Psychiat-ric Association, 2004). Since DID patients almost universally suffer from co-morbid PTSD, the reader may wish to consult those documents in addition to these Guidelines in developing treatment plans for dis-sociative disorder patients.
Several studies have noted an association between domestic violence and psychological distress. However, little empirical
work has examined behavioral and psychological difficulties, especially with reference to dissociation and guilt, in victims
of domestic violence in Northern Ireland. In addition, childhood abuse history has tended not to be assessed in studies conducted
in the Province. Using measures designed to assess behavioral and psychological difficulties that are problematic to self
and/or others (that is, Brief Symptoms Inventory, General Health Questionnaire, Guilt Inventory), dissociation (that is, Dissociative
Experiences Scale, Peritraumatic Dissociative Experiences Questionnaire) and trauma (that is, Traumatic Experiences Checklist),
the current study assessed Northern Irish victims of domestic violence from shelter-type accommodation (N=33) and a comparison sample of women from the general population (N=33). The domestic violence group displayed significantly more psychological difficulties, including higher depression, anxiety
and dissociation scores. Dissociative episodes at the time of an assault were related to higher on-going dissociative experiences.
Finally, the domestic violence sample reported more emotional, physical, and sexual abuse in childhood than the comparison
group. Despite the difficulty generalizing from victims of domestic violence in shelter-type accommodation to all victims
of spousal abuse, the current results highlight the increased levels of psychological distress in those exposed to abuse by
their partner.
This study explores the personality disorder symptoms of women victims of intimate male partner violence (IPV), after controlling
for the contribution of experiences of childhood abuse. Victims of both physical and psychological violence (n = 73) or psychological violence alone (n = 53) were compared with non-abused control women (n = 52). Information about sociodemographic characteristics, childhood abuse, and personality characteristics (MCMI-II) was
obtained through face-to-face structured interviews. Women victims of IPV had higher scores than controls in schizoid, avoidant,
self-defeating personality scales, as well as in the three pathological personality scales (schizotypal, borderline and paranoid).
Both physical and psychological IPV were strongly associated with personality disorder symptomatology, regardless of the effects
of childhood abuse. These findings underscore the need to screen for personality disorder symptoms in women victims of IPV
when dealing with therapeutic interventions.
We estimated prevalence and assessed correlates of emotional, physical, sexual, and financial mistreatment and potential neglect (defined as an identified need for assistance that no one was actively addressing) of adults aged 60 years or older in a randomly selected national sample.
We compiled a representative sample by random digit dialing across geographic strata. We used computer-assisted telephone interviewing to standardize collection of demographic, risk factor, and mistreatment data. We subjected prevalence estimates and mistreatment correlates to logistic regression.
We analyzed data from 5777 respondents. One-year prevalence was 4.6% for emotional abuse, 1.6% for physical abuse, 0.6% for sexual abuse, 5.1% for potential neglect, and 5.2% for current financial abuse by a family member. One in 10 respondents reported emotional, physical, or sexual mistreatment or potential neglect in the past year. The most consistent correlates of mistreatment across abuse types were low social support and previous traumatic event exposure.
Our data showed that abuse of the elderly is prevalent. Addressing low social support with preventive interventions could have significant public health implications.
Dissociation is a lack of the normal integration of thoughts, feelings, and experiences into the stream of consciousness and memory. Dissociation occurs to some degree in normal individuals and is thought to be more prevalent in persons with major mental illnesses. The Dissociative Experiences Scale (DES) has been developed to offer a means of reliably measuring dissociation in normal and clinical populations. Scale items were developed using clinical data and interviews, scales involving memory loss, and consultations with experts in dissociation. Pilot testing was performed to refine the wording and format of the scale. The scale is a 28-item self-report questionnaire. Subjects were asked to make slashes on 100-mm lines to indicate where they fall on a continuum for each question. In addition, demographic information (age, sex, occupation, and level of education) was collected so that the connection between these variables and scale scores could be examined. The mean of all item scores ranges from 0 to 100 and is called the DES score. The scale was administered to between 10 and 39 subjects in each of the following populations: normal adults, late adolescent college students, and persons suffering from alcoholism, agoraphobia, phobic-anxious disorders, posttraumatic stress disorder, schizophrenia, and multiple personality disorder. Reliability testing of the scale showed that the scale had good test-retest and good split-half reliability. Item-scale score correlations were all significant, indicating good internal consistency and construct validity. A Kruskal-Wallis test and post hoc comparisons of the scores of the eight populations provided evidence of the scale's criterion-referenced validity.(ABSTRACT TRUNCATED AT 250 WORDS)
An empirical test of traumatic bonding theory, the notion that strong emotional attachments are formed by intermittent abuse, is reported. In-depth assessments (interviews plus questionnaires) were conducted on 75 women who had recently left abusive relationships (50 where physical violence had occurred). The study found support for the effect of relationship dynamic factors such as extremity of intermittent maltreatment and power differentials on long-term felt attachment for a former partner, experienced trauma symptoms, and self-esteem, immediately after separation from an abusive partner and again after a six month interim. All three of these measures were significantly intercorrelated within each time period. Each measure at Time 1 correlated significantly with each corresponding measure at Time 2. After six months attachment had decreased by about 27%. Relationship variables (total abuse, intermittency of abuse and power differentials) accounted for 55% of the variance in the attachment measure at Time 2 indicating prolonged effects of abuse suffered in the relationship.
The Dissociative Experiences Scale has proved a reliable and valid instrument to measure dissociation in many groups, but its capacity to distinguish patients with multiple personality disorder from patients with other psychiatric disorders has not yet been conclusively tested.
A discriminant analysis was performed to classify 1,051 subjects as having or not having multiple personality disorder. Another discriminant analysis was performed on a subgroup of 883 subjects more closely representing patients in a typical psychiatric facility in terms of base rates of dissociative disorders. A cutoff score of 30 was also used to classify subjects, and Bayes's theorem, which allows for the calculation of the positive predictive value and the negative predictive value of a screening test, was applied.
According to discriminant analysis of the total study group, the scale's sensitivity was 76% and its specificity was also 76%; according to discriminant analysis of the more representative subgroup, the scale's sensitivity was 76% and its specificity was 85%. Use of the cutoff score of 30 produced similar results. Results of the application of Bayes's theorem showed that 17% of the subjects scoring 30 or higher would actually have multiple personality disorder and 99% of those scoring less than 30 would not have multiple personality disorder.
These results indicate that the Dissociative Experiences Scale performs quite well as a screening instrument to identify subjects with multiple personality disorder. In addition, the consistency of responses to scale items across centers indicates that the symptoms reported by patients with multiple personality disorder are highly similar across diverse geographic centers. This consistency supports the reliability and validity of the diagnosis of multiple personality disorder across centers.
The term "dissociation" has been used to describe a wide range of psychological and psychiatric phenomena. The popular conception of dissociation describes it as a unitary phenomenon, with only quantitative differences in severity between the various dissociative conditions. More recently, it has been argued that the available evidence is more consistent with a model that identifies at least two distinct categories of dissociative phenomena-"detachment" and "compartmentalization"- that have different definitions, mechanisms and treatment implications (Holmes, Brown, Mansell, Fearon, Hunter, Frasquilho & Oakley 2005). This paper presents evidence for this bipartite model of dissociation, followed by definitions and descriptions of detachment and compartmentalization. Possible psychological mechanisms underlying these phenomena are then discussed, with particular emphasis on the nature of compartmentalization in conversion disorder, hypnosis, dissociative amnesia and dissociative identity disorder.
Wepresentprelim i naryresultsfromtheBetrayalTrauma Inventory(BTI) test ingpredictionsfrombetrayaltraumatheory(Freyd, 1994, 1996, in press) about the re la tion ship be tween am ne sia and betrayal by a care giver. TheBTI as sesses trauma his tory us ing behaviorally de fined events in the do mains of sex ual, phys i cal, and emo tional childhoodabuse, aswellasother life timetraumaticevents.Whenpar tic i pants endorseanabuseexpe ri ence,follow-upquestionsassessava ri etyoffactorsincludingmemoryimpairmentandperpetratorrelationship. Prelimi - nary re sults sup port our pre dic tion that abuse per pe trated by a care giver is re lated to less per sis tent memo ries ofabuse.This re la tion ship is sig nif- Jennifer J. Freyd and Anne P. DePrince are af fil i ated with the De part ment of Psychology, Univer sity ofOregon,Eugene,OR.
Race, ethnicity, sexual orientation, migration status, religion and many other cultural factors play an important role in recovery from a traumatic event. However, most conventional attempts to help people recover from trauma do not anticipate or address these factors. Here, a psychologist describes how to recognize the cultural issues that need to be considered for healing. She offers vignettes illustrating these issues, as well as activities for traumatized people to regain their sense of self-esteem, safety, strength and calm.
Numerous studies have examined attachment in intimate partner violence (IPV) perpetration, but less is known about adult attachment insecurity relative to victimization. This study’s objective was to evaluate attachment insecurity as a moderator of the association between IPV victimization and risk of psychiatric symptoms. Data come from a subsample (n = 215) of female healthcare workers in a longitudinal study of violence and health. Structural equation modeling was conducted to evaluate the association between IPV victimization and posttraumatic stress and depressive symptoms and to examine IPV exposure and psychiatric outcomes by levels of attachment insecurity. Findings suggest that anxious attachment confers vulnerability to depression following conflict and highlight the importance of attachment security in the context of interventions for interpersonal violence.
Post-traumatic stress disorder (PTSD) symptoms have been linked to traumatic experiences, including intimate partner violence. However, not all battered women develop PTSD symptoms. The current study tests attachment style as a moderator in the abuse-trauma link among a community sample women in violent and non-violent relationships. Both attachment anxiety and dependency were found to moderate the relation between intimate partner violence and PTSD symptoms. However, attachment closeness did not function as a moderator. Differences in attachment may help to explain why certain victims of domestic abuse may be more susceptible to experiencing PTSD symptoms. Clinically, these findings may aid in the prediction and prevention of PTSD symptoms in women victimized by intimate partner abuse.
Childhood and adolescent dissociative disorders are being diagnosed increasingly by mental health professionals who work with traumatized children. The identification of these conditions is hampered by the high background level of normal dissociative behavior observed in children and adolescents. An awareness of the underlying developmental processes and issues can aid in the identification of pathologic dissociation.
Using prospective data gathered from a sample of 323 college women over a 10-week academic quarter, the present study examined whether dissociation and posttraumatic symptomatology mediate or moderate sexual revictimization. Results indicated that posttraumatic symptomatology, but not dissociation, moderated the link between previous and subsequent sexual victimization. Neither posttraumatic symptomatology nor dissociation mediated revictimization.
Both the interrater and test-retest-retest reliability of axis I and axis II disorders were assessed using the Structured Clinical Interview for DSM-IV Axis I Disorders (SCID-I) and the Diagnostic Interview for DSM-IV Personality Disorders (DIPD-IV). Fair-good median interrater kappa (.40-.75) were found for all axis II disorders diagnosed five times or more, except antisocial personality disorder (1.0). All of the test-retest kappa for axis II disorders, except for narcissistic personality disorder (1.0) and paranoid personality disorder (.39), were also found to be fair-good. Interrater and test-retest dimensional reliability figures for axis II were generally higher than those for their categorical counterparts; most were in the excellent range (> .75). In terms of axis I, excellent median interrater kappa were found for six of the 10 disorders diagnosed five times or more, whereas fair-good median interrater kappa were found for the other four axis I disorders. In general, test-retest reliability figures for axis I disorders were somewhat lower than the interrater reliability figures. Three test-retest kappa were in the excellent range, six were in the fair-good range, and one (for dysthymia) was in the poor range (.35). Taken together, the results of this study suggest that both axis I and axis II disorders can be diagnosed reliably when using appropriate semistructured interviews. They also suggest that the reliability of axis II disorders is roughly equivalent to that reliability found for most axis I disorders.
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