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Research and clinical issues in trauma and dissociation: Ethical and logical fallacies, myths, misreports, and misrepresentations
Abstract
The creation of a new journal on trauma and dissociation is an opportunity to take stock of existing models and theories in order to distinguish mythical, and sometimes dangerous, stories from established facts. To describe the professional, scientific, clinical, and ethical strategies and fallacies that must be envisaged when considering reports, claims, and recommendations relevant to trauma and dissociation. After a general overview, two current debates in the field, the stabilisation controversy and the false/recovered memory controversy, are examined in detail to illustrate such issues. Misrepresentations, misreports, ethical and logical fallacies are frequent in the general and scientific literature regarding the stabilisation and false/recovered memory controversies. A call is made for researchers and clinicians to strengthen their knowledge of and ability to identify such cognitive, logical, and ethical manoeuvres both in scientific literature and general media reports.
... However, in reality, these arguments are fallacious, and most philosophers and logicians have referred to them as 'logical fallacies.' These fallacies have a negative impact on our behaviour, true perception of things and crucial decision-making processes [1,14,25]. Over the course of centuries, researchers have been driven to uncover the nature, types, and construction of these fallacious arguments based on logical principles. ...
... They found that these fallacies are the result of individuals' failure to employ correct reasoning rules. This failure becomes apparent when they present logically incorrect premises and subsequently draw erroneous conclusions, leading to serious consequences on the individual and societal levels [1,14,25]. ...
... Additionally, they have sought to determine effective strategies to counteract these fallacies, aiming to help individuals make sound and effective decisions in their daily lives. Among these essential strategies is the cultivation of critical thinking skills, understanding the criteria for proper argumentation, and training individuals to apply these skills [23,24,25]. ...
... The concept was first proposed by Peter Freyd, a mathematician, himself accused of CSA by his daughter (Rydberg, 2017). False memories of CSA are often asserted to be created by the individual at the prompting of a therapist (Loftus and Pickrell, 1995) The most significant proponent of this theory is Loftus (1993), a psychologist, whose research has been used in many criminal cases, including the Cosby trial (Rydberg, 2017). ...
... The concept was first proposed by Peter Freyd, a mathematician, himself accused of CSA by his daughter (Rydberg, 2017). False memories of CSA are often asserted to be created by the individual at the prompting of a therapist (Loftus and Pickrell, 1995) The most significant proponent of this theory is Loftus (1993), a psychologist, whose research has been used in many criminal cases, including the Cosby trial (Rydberg, 2017). In their most cited research, Loftus and Pickrell (1995) carried out a study with 24 participants where they were given a booklet reporting four memories gathered from an older relative. ...
... In a recent Australian case, a perpetrator who had been convicted of assaulting multiple victims, confessed to abusing a boy. The victim, now an adult, did not remember, although he did have symptoms of trauma (Rydberg, 2017). Two individuals who Loftus described as 'proving' false memories later achieved convictions for the abuse they experienced (Brand and McEwen, 2016). ...
There is a great deal of research into multiple aspects of childhood sexual abuse, including prevalence, effects, treatment and recovery. However, very little research focusses on the knowledge held by people who have experienced CSA, and far fewer studies are designed by people who have experienced it. This thesis outlines insider designed and delivered research. It employs a salutogenic approach to examine what helps and hinders recovering. These issues are explored through thematic analysis of a qualitative survey (n=140) and 21 interviews. Participants described three types of harm caused by the abuse they had experienced, including physical and mental health consequences but also an underlying, enduring sense of danger. The results demonstrate that adults who have experienced CSA are active in their recovering, which they conceptualise as a movement towards health and well-being, rather than a binary of either being ill or well. Health services were very useful, particularly counselling and therapy. Respondents also valued personal relationships and interactions in supporting recovering. Finally, they described a sense of flow, a pleasurable absorption in a task, as being highly beneficial. However, they also described the ways in which society, at every level from micro to macro, inhibited recovering. Thus, they called for fundamental societal change, challenging destructive discourses around CSA and inhibiting structural issues. Further research is required to establish if these beneficial actions and challenges apply equally to individuals who identify as being in earlier stages of recovering.
... Est alors apparu un dé bat sur l'é mergence de possibles « faux souvenirs » chez ces patients, certains considé rant qu'oublier de tels é vé nements est impossible de par leur gravité , et que les ré cits sont tellement é difiants qu'ils ne peuvent pas reflé ter la ré alité , telles des violences sexuelles ritualisé es sur des enfants, voire sur des bé bé s, des meurtres d'enfants, parfois dans des groupes organisé s autour de rituels dits « sataniques ». Alors que les tenants du « syndrome des faux souvenirs » considè rent que ces souvenirs ont é té implanté s en mé moire par des suggestions de thé rapeutes et l'influence de mé dias, il ne leur vient pas à l'esprit que l'inverse peut être vrai, à savoir que l'inexistence de tels crimes, l'innocence des auteurs pré sumé s puissent être le fait de suggestions (internes ou externes) [94]. ...
... Nous observons que ces thé matiques font souvent l'objet de dé bats passionné s, voire parfois de dé passements du code de dé ontologie ou é thique. À ce sujet, Rydberg [94] dé crit comment Loftus utilisa des moyens les plus discutables dans le but de prouver sa thé orie sur les « faux souvenirs ». ...
Résumé
Le trouble dissociatif de l’identité (TDI) fait l’objet de controverses dans la littérature scientifique et dans la pratique clinique. Cet article relève les principales croyances des cliniciens et les confronte aux études scientifiques sur ce sujet par une présentation des principales recherches des spécialistes du TDI et des opposants à ce trouble. Il résulte de cette revue de la littérature que (1) le TDI est un trouble différent de la schizophrénie ; (2) qu’il existe en dehors de toute influence iatrogène du thérapeute ou des médias ; (3) ces patients ne sont pas particulièrement sujets à la suggestibilité ni à la tendance à l’affabulation ; (4) le TDI apparaît en dehors de tout traitement hypnothérapeutique ; (5) il est le plus sévère des troubles d’origine traumatique ; (6) l’amnésie de traumas de l’enfance est un phénomène démontré ; (7) l’étendue des violences physiques et sexuelles extrêmes réalisées par des individus ou des groupes organisés sur des enfants, parfois des bébés, est connue des instances policières et judiciaires.
... En effet, nier l'existence de l'amnésie traumatique engendre des conséquences désastreuses pour les victimes. Pourtant, souvent, les victimes d'abus sexuel durant l'enfance partent avec un désavantage notoire tant il est communément admis que la divulgation tardive des abus sexuels sape la crédibilité des signalements d'abus (Rydberg, 2017). Celles-ci se retrouvent alors dans une situation où l'on doute de leur parole, ce qui est susceptible de générer de la retraumatisation, les vulnérabilisant encore davantage. ...
... Il percorso di cura di A. ha seguito il modello per Fasi di Intervento considerato dalla letteratura standard di cura per il Disturbo da Stress Post Traumatico Complesso e per i Disturbi Dissociativi (Chu, Dell, Van der Hart, Cardeña, Barach, Somer e Twombly, 2011;Rydberg, 2017). ...
Psicologia clinica dello sviluppo (ISSN 1824-078X)
Following on from the review of the prevalence and diagnosis of PTSD in Chapter 2, this chapter first takes a critical stance in considering the ways in which different conceptualisations of normality and deviance are socially constructed.
Cette thèse sur travaux aborde les troubles dissociatifs tels que décrits par les classifications internationales DSM et CIM à travers dix articles. Dans ce domaine une définition claire de la dissociation s’impose et nous suivons en cela la théorie de la dissociation structurelle de la personnalité. Celle-ci propose que, dans les suites d’une situation traumatisante et par un échec d’intégration, la personnalité d’un sujet peut se diviser (se dissocier), en plusieurs parties dissociatives : une partie dite ‘partie apparemment normale’ continue de s’engager dans des actions de la vie quotidienne et évite une ou plusieurs parties dissociatives dites ‘parties émotionnelles’ restées fixées sur la situation traumatique et qui s’engagent dans des actions ressemblant aux défenses animales face à une menace. La première partie de cette thèse se concentre sur la reconnaissance de ces troubles, en particulier du trouble dissociatif de l’identité qui est sans doute le trouble psychiatrique le plus controversé. Puis nous détaillons la conceptualisation des troubles dissociatifs selon la théorie de la dissociation structurelle de la personnalité. La deuxième partie de la thèse s’intéresse aux procédés diagnostiques des troubles dissociatifs. Un article présente l’étude de validité et de fiabilité du SCID-D, entretien semi-structuré pour le diagnostic des symptômes et troubles dissociatifs selon le DSM-5 et la CIM-11. Nous abordons aussi des procédés diagnostiques plus adaptés à des cas de trouble dissociatif nécessitant une approche au plus près de la singularité du patient. La troisième partie s’intéresse aux principes et moyens thérapeutiques utiles pour surmonter ces troubles sévères. Plusieurs articles sont présentés, en particulier sur le thème de l’intégration des souvenirs traumatiques et des parties dissociatives. Nous y décrivons dans le détail ces interventions thérapeutiques. Nous prenons également en compte les aspects relationnels complexes de ces situations cliniques, en particulier les aspects contre-transférentiels. Reconnaître, diagnostiquer et surmonter les troubles dissociatifs est un défi majeur pour les patients mais aussi pour les professionnels qui doivent souvent dépasser leurs fondamentaux théoriques pour rencontrer le patient dans une singularité inattendue. Il s’agit également d’un défi en termes de politique de santé publique et de formation des professionnels, puisque les troubles dissociatifs s’avèrent être des troubles fréquents et fortement invalidants.
Štúdia sa venuje otázke výskytu sexuálneho zneužívania detí (CSA) a problému latencie. Upozorňuje, že pri úsilí o identifikáciu prípadov CSA hrozí dvojaké riziko mylných záverov (mylne pozitívne a mylne negatívne závery). Zdôrazňuje, že nepodložené a nepravdivé obvinenia nie sú synonymom krivých obvinení a ponúka prierez teoretickým modelom ciest k nepravdivým obvineniam z CSA. Sumarizuje výsledky a limity zahraničných výskumov o výskyte krivých obvinení z CSA. Objasňuje prečo profesionálna skúsenosť ani systematické metódy posudzovania vierohodnosti výpovede nie sú spoľahlivými nástrojmi na odhalenie krivých obvinení z CSA. Pobáda k obozretnosti pred trúfalými tvrdeniami o výskyte krivých obvinení z CSA.
Understanding that suggestive practices can promote false beliefs and false memories for childhood events is important in many settings (e.g., psychotherapeutic, medical, legal). The generalizability of findings from memory implantation studies has been questioned due to variability in estimates across studies. Such variability is partly due to false memories having been operationalized differently across studies and to differences in memory induction techniques. We explored ways of defining false memory based on memory science and developed a reliable coding system that we applied to reports from eight published implantation studies (N=423). Independent raters coded transcripts using seven criteria: accepting the suggestion, elaboration beyond the suggestion, imagery, coherence, emotion, memory statements, and not rejecting the suggestion. Using this scheme, 30.4% of cases were classified as false memories and another 23% were classified as having accepted the event to some degree. When the suggestion included self-relevant information, an imagination procedure, and was not accompanied by a photo depicting the event, the memory formation rate was 46.1%. Our research demonstrates a useful procedure for systematically combining data that are not amenable to meta-analysis, and provides the most valid estimate of false memory formation and associated moderating factors within the implantation literature to date.
Nonbelieved memories (NBMs) highlight the independence between distinct metamemorial judgements that contribute to the experience of remembering. Initial definitions of NBMs portrayed them as involving the withdrawal of belief in occurrence despite sustained recollection. While people rate belief for their NBMs as weaker than recollection, the average difference is too small to support the idea that autobiographical belief is completely withdrawn in all cases. Furthermore, autobiographical belief and recollection ratings vary considerably across NBMs. In two studies, we reanalysed data from prior studies to examine whether NBM reports reflect a single category or multiple sub-categories using cluster analytic methods. In Study 1, we identified three sub-types of NBMs. In Study 2 we incorporated the concept of belief in accuracy, and found that two of the clusters from Study 1 split into two clusters apiece. All clusters were characterised by higher recollection than belief in occurrence ratings, and clusters were differentiated by the degree of difference between these variables. In both studies the clusters were discriminated by a number of memory characteristic ratings and by reasons reported as leading to the alteration of belief. Implications for understanding the remembering of past events and predicting the creation of NBMs are discussed.
Objective:
The Trauma Model of dissociative identity disorder (DID) posits that DID is etiologically related to chronic neglect and physical and/or sexual abuse in childhood. In contrast, the Fantasy Model posits that DID can be simulated and is mediated by high suggestibility, fantasy proneness, and sociocultural influences. To date, these two models have not been jointly tested in individuals with DID in an empirical manner.
Method:
This study included matched groups [patients (n = 33) and controls (n = 32)] that were compared on psychological Trauma and Fantasy measures: diagnosed genuine DID (DID-G, n = 17), DID-simulating healthy controls (DID-S, n = 16), individuals with post-traumatic stress disorder (PTSD, n = 16), and healthy controls (HC, n = 16). Additionally, personality-state-dependent measures were obtained for DID-G and DID-S; both neutral personality states (NPS) and trauma-related personality states (TPS) were tested.
Conclusion:
For Trauma measures, the DID-G group had the highest scores, with TPS higher than NPS, followed by the PTSD, DID-S, and HC groups. The DID-G group was not more fantasy-prone or suggestible and did not generate more false memories. Malingering measures were inconclusive. Evidence consistently supported the Trauma Model of DID and challenges the core hypothesis of the Fantasy Model.
This Special Communication argues against changing the definition of posttraumatic stress disorder in DSM-5.Are changes to the definition of posttraumatic stress disorder in DSM-5 a step forward?—No. Article InformationCorresponding Author: Charles W. Hoge, MD, Walter Reed Army Institute of Research, US Army Medical Research and Material Comand, 503 Robert Grant Ave, Silver Spring, MD 20910 (charles.w.hoge.civ@mail.mil).Submitted for Publication: September 15, 2015; final revision received January 13, 2016; accepted January 15, 2016.Published Online: May 25, 2016. doi:10.1001/jamapsychiatry.2016.0647.Conflict of Interest Disclosures: Dr McFarlane is involved in expert testimony about veterans and emergency service personnel. Dr Rothbaum owns equity in Virtually Better Inc, which creates virtual-reality products. No other disclosures were reported.Disclaimer: The opinions expressed herein are those of the authors and do not reflect an official position of the US Army, Department of Defense, Veterans Affairs, or other institutions listed.
The etiology of dissociative identity disorder (DID) remains a topic of debate. Proponents of the fantasy model and the trauma model of DID have both called for more empirical research. To this end, the current study presents new and extended data analyses of a previously published H2O positron emission tomography imaging study. This study included 29 subjects: 11 patients with DID and 10 high- and 8 low-fantasy-prone DID-simulating mentally healthy control subjects. All subjects underwent an autobiographical memory script-driven (neutral and trauma related) imagery paradigm in 2 (simulated) dissociative personality states (neutral and trauma related). Psychobiological and psychophysiological data were obtained. Results of the new post-hoc tests on the psychophysiological responses support the trauma model. New results of the brain imaging data did not support the fantasy model. This study extends previously published results by offering important new supporting data for the trauma model of DID.
According to current treatment guidelines for Complex PTSD (cPTSD), psychotherapy for adults with cPTSD should start with a "stabilization phase." This phase, focusing on teaching self-regulation strategies, was designed to ensure that an individual would be better able to tolerate trauma-focused treatment. The purpose of this paper is to critically evaluate the research underlying these treatment guidelines for cPTSD, and to specifically address the question as to whether a phase-based approach is needed. As reviewed in this paper, the research supporting the need for phase-based treatment for individuals with cPTSD is methodologically limited. Further, there is no rigorous research to support the views that: (1) a phase-based approach is necessary for positive treatment outcomes for adults with cPTSD, (2) front-line trauma-focused treatments have unacceptable risks or that adults with cPTSD do not respond to them, and (3) adults with cPTSD profit significantly more from trauma-focused treatments when preceded by a stabilization phase. The current treatment guidelines for cPTSD may therefore be too conservative, risking that patients are denied or delayed in receiving conventional evidence-based treatments from which they might profit.
Eye movement desensitization and reprocessing (EMDR) is an efficacious treatment for post-traumatic stress disorder. In EMDR, patients recall a distressing memory and simultaneously make eye movements (EM). Both tasks are considered to require limited working memory (WM) resources. Because this leaves fewer resources available for memory retrieval, the memory should become less vivid and less emotional during future recall. In EMDR analogue studies, a standardized procedure has been used, in which participants receive the same dual task manipulation of 1 EM cycle per second (1 Hz). From a WM perspective, the WM taxation of the dual task might be titrated to the WM taxation of the memory image. We hypothesized that highly vivid images are more affected by high WM taxation and less vivid images are more affected by low WM taxation. In study 1, 34 participants performed a reaction time task, and rated image vividness, and difficulty of retrieving an image, during five speeds of EM and no EM. Both a high WM taxing frequency (fast EM; 1.2 Hz) and a low WM taxing frequency (slow EM; 0.8 Hz) were selected. In study 2, 72 participants recalled three highly vivid aversive autobiographical memory images (n = 36) or three less vivid images (n = 36) under each of three conditions: recall + fast EM, recall + slow EM, or recall only. Multi-level modeling revealed a consistent pattern for all outcome measures: recall + fast EM led to less emotional, less vivid and more difficult to retrieve images than recall + slow EM and recall only, and the effects of recall + slow EM felt consistently in between the effects of recall + fast EM and recall only, but only differed significantly from recall + fast EM. Crucially, image vividness did not interact with condition on the decrease of emotionality over time, which was inconsistent with the prediction. Implications for understanding the mechanisms of action in memory modification and directions for future research are discussed.
As proposed in a previous article in this journal, eye movement desensitization and reprocessing (EMDR) clinicians treating clients with complex trauma-related disorders may benefit from knowing and applying the theory of structural dissociation of the personality (TSDP) and its accompanying psychology of action. TSDP postulates that dissociation of the personality is the main feature of traumatization and a wide range of trauma-related disorders from simple posttraumatic stress disorder (PTSD) to dissociative identity disorder (DID). The theory may help EMDR therapists to develop a comprehensive map for under- standing the problems of clients with complex trauma-related disorders and to formulate and carry out a treatment plan. The expert consensus model in complex trauma is phase-oriented treatment in which a stabilization and preparation phase precedes the treatment of traumatic memories. This article focuses on the initial stabilization and preparatory phase, which is very important to safely and effectively use EMDR in treating complex trauma. Central themes are (a) working with maladaptive beliefs, (b) overcoming dissociative phobias, and (c) an extended application of resourcing.
Abstract Research shows many organizations overlook needs and opportunities to strengthen ethics. Barriers can make it hard to see the need for stronger ethics and even harder to take effective action. These barriers include the organization's misleading use of language, misuse of an ethics code, culture of silence, strategies of justification, institutional betrayal, and ethical fallacies. Ethics placebos tend to take the place of steps to see, solve, and prevent problems. This article reviews relevant research and specific steps that create change.
Because of the dramatic increases of culturally diverse individuals in the United States, indigenous perspectives of healing must be understood in the context of interdependent cultural selves. The authors present an extensive review of the literature with a focus on understanding the role of spirituality, balancing energies, close social networks, and interconnectedness in indigenous healing perspectives and philosophies. Examples of indigenous healing approaches are presented, and implications for counseling and research are discussed.
Eye movement desensitization and reprocessing (EMDR) psychotherapy can play a major role in phaseoriented treatment of complex trauma-related disorders. In terms of the theory of structural dissociation of the personality and its related psychology of action, a previous article described Phase 1 treatment—Stabilization, Symptom Reduction, and Skills Training—emphasizing the use of EMDR procedures in this phase. Phase 2 treatment mainly involves applications of EMDR processing in overcoming the phobia of traumatic memories and their subsequent integration. Phase 3 treatment focuses on further integration of the personality, which includes overcoming various phobias pertaining to adaptive functioning in daily life. This article emphasizes treatment approaches that assist therapists in incorporating EMDR protocols in Phases 2 and 3 of phase-oriented treatment without exceeding clients' integrative capacity or window of tolerance.
Background
In accordance with the Theory of Structural Dissociation of the Personality (TSDP), studies of dissociative identity disorder (DID) have documented that two prototypical dissociative subsystems of the personality, the “Emotional Part” (EP) and the “Apparently Normal Part” (ANP), have different biopsychosocial reactions to supraliminal and subliminal trauma-related cues and that these reactions cannot be mimicked by fantasy prone healthy controls nor by actors.
Methods
Arterial spin labeling perfusion MRI was used to test the hypotheses that ANP and EP in DID have different perfusion patterns in response to rest instructions, and that perfusion is different in actors who were instructed to simulate ANP and EP. In a follow-up study, regional cerebral blood flow of DID patients was compared with the activation pattern of healthy non-simulating controls.
Results
Compared to EP, ANP showed elevated perfusion in bilateral thalamus. Compared to ANP, EP had increased perfusion in the dorsomedial prefrontal cortex, primary somatosensory cortex, and motor-related areas. Perfusion patterns for simulated ANP and EP were different. Fitting their reported role-play strategies, the actors activated brain structures involved in visual mental imagery and empathizing feelings. The follow-up study demonstrated elevated perfusion in the left temporal lobe in DID patients, whereas non-simulating healthy controls had increased activity in areas which mediate the mental construction of past and future episodic events.
Conclusion
DID involves dissociative part-dependent resting-state differences. Compared to ANP, EP activated brain structures involved in self-referencing and sensorimotor actions more. Actors had different perfusion patterns compared to genuine ANP and EP. Comparisons of neural activity for individuals with DID and non-DID simulating controls suggest that the resting-state features of ANP and EP in DID are not due to imagination. The findings are consistent with TSDP and inconsistent with the idea that DID is caused by suggestion, fantasy proneness, and role-playing.
This is a personal story regarding one woman's experience of serving as a case study protagonist and later having a psychologist uncover her identity and retell her life story in the name of scientific investigative journalism. As a participant in a psychological case report, I believed that my confidentiality would be protected. Unfortunately, this case study participant found herself in the middle of the Memory Wars, and that turned out to be the catalyst for an unwanted inquiry into my life. A well-known memory researcher hired a private investigator to find me, gained access to a great deal of private information about me, and published this in detail without my permission. I discuss in this article how these actions affected my life in some very serious ways. I raise several issues about the meaning of my experience for further case study authors and the clients whose lives they present, as well as questions about the duties of psychologists to the subjects of their research and inquiry.
This commentary addresses the emotionally powerful account of Nicole Taus Kluemper from the perspective of a psychologist familiar with the administrative operation of the American Psychological Association (APA) and the ethics of the profession. The application of the APA's Ethical Principles of Psychologists and Code of Conduct to the case is discussed, and alternative methods of response that researchers who have concerns about case studies might use are offered. The author concludes that existing ethical principles-the aspirational standards in particular-do bear upon the matter in question. However, the enforceable code of conduct is not sufficiently clear about obligations to those whom psychologists publicly discuss when the psychologist does not have a specific duty of care to an individual.
We respond to Lynn et al.'s (2014) comments on our review (Dalenberg et al., 2012) demonstrating the superiority of the trauma model (TM) over the fantasy model (FM) in explaining the trauma-dissociation relationship. Lynn et al. conceded that our meta-analytic results support the TM hypothesis that trauma exposure is a causal risk factor for the development of dissociation. Although Lynn et al. suggested that our meta-analyses were selective, we respond that each omitted study failed to meet inclusion criteria; our meta-analyses thus reflect a balanced view of the predominant trauma-dissociation findings. In contrast, Lynn et al. were hypercritical of studies that supported the TM while ignoring methodological problems in studies presented as supportive of the FM. We clarify Lynn et al.'s misunderstandings of the TM and demonstrate consistent superiority in prediction of time course of dissociative symptoms, response to psychotherapy of dissociative patients, and pattern of relationships of trauma to dissociation. We defend our decision not to include studies using the Dissociative Experiences Scale-Comparison, a rarely used revision of the Dissociative Experiences Scale that shares less than 10% of the variance with the original scale. We highlight several areas of agreement: (a) Trauma plays a complex role in dissociation, involving indirect and direct paths; (b) dissociation-suggestibility relationships are small; and (c) controls and measurement issues should be addressed in future suggestibility and dissociation research. Considering the lack of evidence that dissociative individuals simply fantasize trauma, future researchers should examine more complex models of trauma and valid measures of dissociation. (PsycINFO Database Record (c) 2014 APA, all rights reserved).
Dalenberg et al. (2012) argued that convincing evidence (a) supports the longstanding trauma model (TM), which posits that early trauma plays a key role in the genesis of dissociation; and (b) refutes the fantasy model (FM), which posits that fantasy proneness, suggestibility, cognitive failures, and other variables foster dissociation. We review evidence bearing on Dalenberg et al.'s 8 predictions and find them largely wanting in empirical support. We contend that the authors repeat errors committed by many previous proponents of the TM, such as attributing a central etiological role to trauma in the absence of sufficient evidence. Specifically, Dalenberg et al. leap too quickly from correlational data to causal conclusions, do not adequately consider the lack of corroboration of abuse in many studies, and underestimate the relation between dissociation and false memories. Nevertheless, we identify points of agreement between the TM and FM regarding potential moderators and mediators of dissociative symptoms (e.g., family environment, biological vulnerabilities) and the hypothesis that dissociative identity disorder is a disorder of self-understanding. We acknowledge that trauma may play a causal role in dissociation but that this role is less central and specific than Dalenberg et al. contend. Finally, although a key assumption of the TM is dissociative amnesia, the notion that people can encode traumatic experiences without being able to recall them lacks strong empirical support. Accordingly, we conclude that the field should now abandon the simple trauma-dissociation model and embrace multifactorial models that accommodate the diversity of causes of dissociation and dissociative disorders. (PsycINFO Database Record (c) 2014 APA, all rights reserved).
The Theory of Structural Dissociation of the Personality (TSDP) proposes that dissociative identity disorder (DID) patients are fixed in traumatic memories as "Emotional Parts" (EP), but mentally avoid these as "Apparently Normal Parts" of the personality (ANP). We tested the hypotheses that ANP and EP have different biopsychosocial reactions to subliminally presented angry and neutral faces, and that actors instructed and motivated to simulate ANP and EP react differently.
Women with DID and matched healthy female actors (CON) were as ANP and EP (DIDanp, DIDep, CONanp, CONep) consecutively exposed to masked neutral and angry faces. Their brain activation was monitored using functional magnetic resonance imaging. The black-and-white dotted masks preceding and following the faces each had a centered colored dot, but in a different color. Participants were instructed to immediately press a button after a perceived color change. State anxiety was assessed after each run using the STAI-S. Final statistical analyses were conducted on 11 DID patients and 15 controls for differences in neural activity, and 13 DID patients and 15 controls for differences in behavior and psychometric measures.
Differences between ANP and EP in DID patients and between DID and CON in the two dissociative parts of the personality were generally larger for neutral than for angry faces. The longest reaction times (RTs) existed for DIDep when exposed to neutral faces. Compared to DIDanp, DIDep was associated with more activation of the parahippocampal gyrus. Following neutral faces and compared to CONep, DIDep had more activation in the brainstem, face-sensitive regions, and motor-related areas. DIDanp showed a decreased activity all over the brain in the neutral and angry face condition. There were neither significant within differences nor significant between group differences in state anxiety. CON was not able to simulate genuine ANP and EP biopsychosocially.
DID patients have dissociative part-dependent biopsychosocial reactions to masked neutral and angry faces. As EP, they are overactivated, and as ANP underactivated. The findings support TSDP. Major clinical implications are discussed.
The diagnostic concepts of post-traumatic stress disorder (PTSD) and other disorders specifically associated with stress have been intensively discussed among neuro- and social scientists, clinicians, epidemiologists, public health planners and humanitarian aid workers around the world. PTSD and adjustment disorder are among the most widely used diagnoses in mental health care worldwide. This paper describes proposals that aim to maximize clinical utility for the classification and grouping of disorders specifically associated with stress in the forthcoming 11th revision of the International Classification of Diseases (ICD-11). Proposals include a narrower concept for PTSD that does not allow the diagnosis to be made based entirely on non-specific symptoms; a new complex PTSD category that comprises three clusters of intra- and interpersonal symptoms in addition to core PTSD symptoms; a new diagnosis of prolonged grief disorder, used to describe patients that undergo an intensely painful, disabling, and abnormally persistent response to bereavement; a major revision of "adjustment disorder" involving increased specification of symptoms; and a conceptualization of "acute stress reaction" as a normal phenomenon that still may require clinical intervention. These proposals were developed with specific considerations given to clinical utility and global applicability in both low- and high-income countries.
One hundred twenty-nine women with previously documented histories of sexual victimization in childhood were interviewed and asked detailed questions about their abuse histories to answer the question "Do people actually forget traumatic events such as child sexual abuse, and if so, how common is such forgetting?" A large proportion of the women (38%) did not recall the abuse that had been reported 17 years earlier. Women who were younger at the time of the abuse and those who were molested by someone they knew were more likely to have no recall of the abuse. The implications for research and practice are discussed. Long periods with no memory of abuse should not be regarded as evidence that the abuse did not occur.
This article presents the history, verbatim transcripts, and behavioral observations of a child's disclosure of sexual abuse to Dr. David Corwin in 1984 and the spontaneous return of that reportedly unrecallable memory during an interview between the same individual, now a young adult, and Dr. Corwin 11 years later. Both interviews were videotape recorded. The significance, limitations, and clinical implications of this unique case study are discussed. Five commentaries by researchers from differing empirical perspectives who have reviewed these videotape-recorded interviews follow this article.
The aim of this study was to examine the effect of eye-movements on subjective and psychophysiological measures of arousal and distress associated with positive and negative autobiographical memories. These memories were ‘brought-to-mind’ whilst engaging in eye-movement or eyes-stationary conditions in a counterbalanced within subjects design, with pre and post eye-condition subjective ratings of emotional valence and image vividness. Participants also rated current symptomatology associated with negative memories using the Impact of Events Scale. Engagement in eye-movements compared to the eyes-stationary condition resulted in significant reductions on measures of vividness and emotional valence for both positive and negative autobiographical memories. Reductions in electrodermal arousal were only observed when engaging in eye-movements following elicitation of the negative memory. This effect was observed independently of symptom severity.
Data regarding the development of a structured interview measuring alterations that may accompany extreme stress are presented. A list of 27 criteria often seen in response to extreme trauma and not addressed by DSM-IV criteria for posttraumatic stress disorder (PTSD) were generated based on a systematic review of the literature and a survey of 50 experts. A structured interview for disorders of extreme stress (SIDES) measuring the presence of these criteria was administered to 520 subjects as part of the DSM-IV PTSD field trials. Inter-rater reliability as measured by Kappa coefficients for lifetime Disorders of Extreme Stress was .81. Internal consistency using coefficient alpha ranged from .53 to .96. Results indicate that the SIDES is a useful tool for investigation of response to extremes stress.
Responds to comments by J. L. Alpert, P. Freyd, S. T. Gold, M. Pendergrast, D. P. Poole et al, D. H. Gleaves and Jennifer J. Freyd, J. F. Kihlstrom, D. Spiegel, J. de Rivera, and K. W. Saakvitne et al (all published in 1997) regarding the author's (see record 83-37387) article questioning the empirical basis for claims of a false memory syndrome. The author reasserts that if psychology is a scientific discipline, then claims by false memory syndrome proponents should be subject to the same scrutiny and held to the same scientific standards as those that are routinely applied to other claims. Pope also responds to the individual concerns of each commentary.
In the past two decades, much evidence has accumulated unequivocally demonstrating that child abuse and neglect is associated with a marked increase in risk for major psychiatric disorders (major depression, bipolar disorder, post-traumatic stress disorder [PTSD], substance and alcohol abuse, and others) and medical disorders (cardiovascular disease, diabetes, irritable bowel syndrome, asthma, and others). Moreover, the course of psychiatric disorders in individuals exposed to childhood maltreatment is more severe. Recently, the biological substrates underlying this diathesis to medical and psychiatric morbidity have been studied. This Review summarizes many of the persistent biological alterations associated with childhood maltreatment including changes in neuroendocrine and neurotransmitter systems and pro-inflammatory cytokines in addition to specific alterations in brain areas associated with mood regulation. Finally, I discuss several candidate gene polymorphisms that interact with childhood maltreatment to modulate vulnerability to major depression and PTSD and epigenetic mechanisms thought to transduce environmental stressors into disease vulnerability.
Forensic psychologist R. Gardner formulated cluster of eight symptoms which characterize the parental alienation syndrome: 1. A campaign of denigration. 2. Absurd rationalization for the deprecation. 3. Lack of ambivalence. 4. The "independent-thinker" phenomenon. 5. Reflexive support of the alienating parent in the parental conflict. 6. Absence of guilt over cruelty to and/or exploitation of the alienated parent. 7. The presence of borrowed scenarios. 8. Spread of the animosity to the friends and/or extended family of the alienated parent. The authors in their study of 100 psychology and psychiatry expert examinations in cases of parental law suits concerning custody disagreement find frequent psychopathology in children and their parents. Mothers more frequently interfere with father visitation of children, fathers are more frequently aggressive. Explicit diagnosis of "parental alienation syndrome" is sporadic. For description of dynamic of disrupted family the normally used diagnostic categories are more suitable. The Czech translation "syndrom odcizeného rodiče" is more adequate then "syndrom zavrženého rodiče".
Legal actions of alleged abuse victims based on recovered memories of childhood sexual abuse (CSA) have been challenged arguing that the concept of repressed memories does not meet a generally accepted standard of science. A recent review of the scientific literature on amnesia for CSA concluded that the evidence was insufficient. The issues revolve around: (1) the existence of amnesia for CSA, and (2) the accuracy of recovered memories. A total of 25 studies on amnesia for CSA now exist, all of which demonstrate amnesia in a subpopulation: no study failed to find it, including recent studies with design improvements such as random sampling and prospective designs that address weaknesses in earlier studies. A reasonable conclusion is that amnesia for CSA is a robust finding across studies using very different samples and methods of assessment. Studies addressing the accuracy of recovered abuse memories show that recovered memories are no more or no less accurate than continuous memories for abuse.
Since the late 1980s the authors have been confronted with cases of imitated dissociative identity disorder (DID) in Holland. Because DSM-IV defines 'factitious disorder' as intentional, the term 'imitation of DID' is used here for patients who, partly unconsciously motivated, simulate a DID profile. DID can be imitated due to contagion, to iatrogenesis, or to both. The core dynamics are: (1) the avoidance of responsibility for negative behavior, found mostly in patients with a borderline or antisocial personality disorder; and (2) the compensation for an overwhelming feeling of not being seen. The last, 'hysterical,' dynamic is characterized by identity disturbances varying in severity according to the underlying borderline personality structure. Four cases are described. Differentiating between genuine and imitated DID requires systematic assessment by an experienced clinician. Even then this is difficult, in particular differentiating between flamboyant genuine DID, with coexisting histrionic personality disorder (a minority of patients with genuine DID), and simulated cases. Diagnostic and treatment implications are discussed.
The writings of those who claim to debunk pseudoscience may themselves be unscientific and can be used oppressively in debates within clinical psychology and the NHS.
Some self-proclaimed skeptics of recovered memory claim that traumatic childhood events simply cannot be forgotten at the time only to be remembered later in life. This claim has been made repeatedly by the Advisory Board members of a prominent advocacy group for parents accused of sexual abuse, the so-called False Memory Syndrome Foundation. The research project described in this article identifies and documents the growing number of cases that have been ignored or distorted by such skeptics. To date, this project has documented 35 cases in which recovered memories of traumatic childhood events were corroborated by clear and convincing evidence. This article concludes with some observations about the politics of the false memory movement, particularly the tendency to conceal or omit evidence of corroboration. Several instances of this vanishing facts syndrome are documented and analyzed.
Recognition of the unreliability of findings in the biomedical literature, and especially pharmaceutical trials has led to a number of reforms. These include reporting preregistration of protocols for clinical trials and meta-analysis, reporting standards and making data available to others for all clinical trials, as well as recognition of the influence of conflicts of interest. These improvements are only partially and inconsistently reflected in the literature evaluating psychotherapies. The psychotherapy literature is currently of too poor quality to provide a reliable guide to clinicians, consumers, and policymakers. The literature is dominated by underpowered trials with high risk of bias producing positive effects at a statistically improbable rate. Meta-analyses that are poorly conducted with undisclosed conflicts of interest compound these problems. A number of reforms are proposed. These include accelerating adoption of those already occurring in the pharmaceutical literature. Additionally, psychotherapy research should parallel the orderly sequence of treatment development seen in the pharmaceutical literature. Phase III trials providing the effect sizes of treatments should not be conducted until the acceptability of treatment and the feasibility of accruing sufficient numbers of patients are established. The role of investigator allegiance as a potential and potent source of conflict of interest needs to be recognized. Yet, enforcement of existing standards could counter many of the deficiencies of the current literature, but such enforcement may only come with pressures emanating from outside the field of psychotherapy.
The formation, storage and use of memories is critical for normal adaptive functioning, including the execution of goal-directed behavior, thinking, problem solving and decision-making, and is at the center of a variety of cognitive, addictive, mood, anxiety, and developmental disorders. Memory also significantly contributes to the shaping of human personality and character, and to social interactions. Hence, understanding how memories are formed, stored, retrieved, modified, updated and used potentially impacts many areas in human life, including mental health.
This article explores the ways in which the widely perceived “need for healing” at individual and global level have given rise to a range of new professions within the spiritual marketplace. It examines attitudes to money, the provision of training and the growth of credentialism in this sector of the spiritual service industry, where both clients and practitioners regard healing as important elements in their spiritual quest.
Careful assessment of purported scientific discoveries and the resulting interpretations is a responsibility of every scientist. The area of memory, particularly memory for abuse, has recently seen new, highly publicized claims. These include the proposal of a new diagnostic category, the false memory syndrome; claims about the ease with which extensive autobiographical memories can be implanted; and estimates of the extent therapists use risky practices likely to cause false memory syndrome. This article suggests questions to evaluate these claims and the methods used to promote them. Implications for clinical standards and malpractice are discussed. (PsycINFO Database Record (c) 2012 APA, all rights reserved)
