Dissociation (psychology) 529089 226182932 2008-07-17T05:37:26Z Slashme 451287 [[WP:UNDO|Undid]] revision 222009536 by [[Special:Contributions/Blacksqr|Blacksqr]] ([[User talk:Blacksqr|talk]]): "fixed" split infinitive introduced ambiguity. {{This|psychological dissociation|dissociation}} '''Dissociation''' is a state of acute mental [[decompensation]] in which certain [[thought]]s, [[emotion]]s, [[sensation]]s, and/or [[memory|memories]] are [[Compartmentalization (psychology)|compartmentalized]], diagnosed mostly in individuals with a history of trauma.<ref name="dsm4">{{cite book | last = American Psychiatric Association | authorlink = http://www.psych.org | title = Diagnostic and Statistical Manual of Mental Disorders DSM-IV TR (Text Revision) | url = http://www.psychiatryonline.com/resourceTOC.aspx?resourceID=1 | date = 2000-06 | publisher = American Psychiatric Publishing, Inc. | location = Arlington, VA, USA | isbn = 978-0890420249 | doi = 10.1176/appi.books.9780890423349 | pages = 943 }}</ref><ref name=Brown>{{cite book |last= Brown, Scheflin and Hammond |title=Memory, Trauma Treatment, And the Law |year= 1998 |publisher= W. W. Norton |location= New York, NY |isbn= 0-393-70254-5}}</ref> Dissociative disorders are commonly precipitated by overwhelming stress.<ref name=merck/> This stress may be provoked by seeing or experiencing an accident, a disaster or a traumatic event, including sexual abuse.<ref name=merck>[http://www.merck.com/mmhe/sec07/ch106/ch106a.html Introduction: Amnesia and Related Disorders Merck Manual Home Edition]</ref><ref name=Myers>{{cite book |title=The APSAC Handbook on Child Maltreatment, Second Edition |first=John E.B. |last=Myers |pages=p63 |publisher=Sage Publications |year=2002 |isbn= 0761919929}}</ref> ==History== The [[France|French]] [[psychiatrist]] [[Pierre Janet]] (1859-1947) initially coined the term "[[Splitting (psychology)|splitting]]" in his book ''L'Automatisme psychologique''. There, he emphasized its role as a defensive mechanism employed in response to [[psychological trauma]]. While he considered dissociation an initially effective [[defense mechanism]] that protects the individual psychologically from the impact of overwhelming traumatic events, a habitual tendency to dissociate would likely be a marker of a more pronounced [[psychopathology]]. [[Carl Jung]] described pathological manifestions of dissociation as special or extreme cases of the normal operation of the psyche. This structural dissociation, opposing tension, and hierarchy of basic [[attitude (psychology)|attitudes]] and functions in normal individual consciousness is the basis of Jung's ''[[Psychological Types]]''.<ref name=Jung1991>{{cite book | author = Jung, C.G. | year = 1991 | title = Psychological types | publisher = Routledge London | isbn = 978-0710062994 }}</ref> He theorized that dissociation is a natural necessity for consciousness to operate in one faculty unhampered by the demands of its opposite. Attention to dissociation as a clinical feature has been growing in recent years as knowledge of [[post-traumatic stress disorder]] increased, due to interest in [[dissociative identity disorder]] and the [[multiple personality controversy]], and as [[neuroimaging]] research and population studies show its relevance.<ref>{{cite book | last = Scaer | first = Robert C. | title = The Body Bears the Burden: Trauma, Dissociation, and Disease | publisher = Haworth Medical Press | date = 2001 | location = Binghamton, NY | pages = 97-126 | isbn = 0-78901246-4 }}</ref> ==Diagnosis== The ''[[Diagnostic and Statistical Manual of Mental Disorders|DSM-IV]]'' considers symptoms such as [[depersonalization]], [[derealization]] and [[psychogenic amnesia]] to be core features of [[dissociative disorder]]s.<ref name="DissociativeDisorders">[http://www.psychiatryonline.com/content.aspx?aID=9696 Dissociative Disorders ( Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition )]</ref> However, in the normal population dissociative experiences that are not clinically significant are highly prevalent, with 60% to 65% of the respondents indicating that they have had some dissociative experiences.<ref name=OccrRef04102007>{{cite journal | author = Waller, N.G. | coauthors = Putnam, F.W.; Carlson, E.B. | year = 1996 | title = Types of dissociation and dissociative types: A taxometric analysis of dissociative experiences | journal = Psychological Methods | volume = 1 | issue = 3 | pages = 300–321 | format = pdf | url = http://www.psych.umn.edu/faculty/waller/classes/mult06/taxometrics/wallerputnam.pdf | accessdate = 2008-01-31 | doi = 10.1037/1082-989X.1.3.300}}</ref> The [[Structured_Clinical_Interview_for_DSM-IV#SCID-D|SCID-D]] is a structured interview used to assess and diagnosis dissociation. == Relation to trauma and abuse== Dissociation has been described as one of a constellation of symptoms experienced by some victims of multiple forms of childhood trauma, including physical abuse and sexual abuse.<ref name=salter>{{cite book|title=Transforming Trauma: A Guide to Understanding and Treating Adult Survivors |first=Anna C. |last=Salter, Dr |coauthors=Hilary Eldridge |pages=p220 | year=1995 |publisher=Sage Publications Inc |isbn= 080395509X}}</ref><ref name=Myers/> This is supported by studies which suggest that dissociation is correlated with a history of trauma.<ref name="pmid8659645">{{cite journal | author = van der Kolk BA, Pelcovitz D, Roth S, Mandel FS, McFarlane A, Herman JL | title = Dissociation, somatization, and affect dysregulation: the complexity of adaptation of trauma | journal = Am J Psychiatry | volume = 153 | issue = 7 Suppl | pages = 83–93 | year = 1996 | month = July | pmid = 8659645 | doi = | url = http://ajp.psychiatryonline.org/cgi/pmidlookup?view=long&pmid=8659645 | accessdate = 2008-05-13}}</ref> Dissociation appears to have a high [[Specificity (tests)|specificity]] and low [[Sensitivity (tests)|sensitivity]] to having a self-reported history of trauma.<ref>Briere, J. (2006). "[http://www.johnbriere.com/JNMD%2006%20paper.html Dissociative symptoms and trauma exposure: specificity, affect dysregulation, and posttraumatic stress]," ''Journal of Nervous and Mental Disease'', 194, 78-82.</ref> Symptoms of dissociation resulting from trauma may include depersonalization, psychic numbing, disengagement, or amnesia regarding the events of the abuse. It has been hypothesized that dissociation may provide a temporarily effective defense mechanism in cases of severe trauma; however, in the long term, dissociation is associated with decreased psychological functioning and adjustment.<ref name=Myers/> Other symptoms sometimes found along with dissociation in victims of traumatic abuse (often referred to as "sequelae to abuse") include anxiety, PTSD, low self-esteem, somatization, depression, chronic pain, interpersonal dysfunction, substance abuse, self-multilation and suicidal ideation or actions.<ref name=briere1992>{{cite journal |url=http://www.johnbriere.com/methodological%20csa%20jccp%201992.pdf |title=Methodological Issues in the Study of Sexual Abuse Effects |author=John Briere, Department of Psychiatry, USC School of Medicine |journal=Journal of Consulting and Clinical Psychology |year=1992 |pages=p196–203 |volume=Vol. 60. No. 2}}</ref><ref name=Myers/><ref name=salter/> These symptoms may lead the victim to erroneously present the symptoms as the source of the problem.<ref name=salter/> Chu et al. (1999) reported that [[child abuse]], especially chronic abuse starting at early ages, was related to high levels of dissociative symptoms in a clinical sample,<ref name="merckelback" /> including amnesia for abuse memories.<ref name=chu>{{cite journal |last=Chu |first=J |coauthors= Frey L, Ganzel B, Matthews J |year=1999 |month=May |title=Memories of childhood abuse: dissociation, amnesia, and corroboration |journal=American Journal of Psychiatry |volume=156 |issue=5 |pages=749–55 |pmid = 10327909 |accessdate= 2008-01-16}}</ref> Briere & Runtz (1988) found increased levels of dissociation in a non-clinical sample of adult women who had been sexually abused by a significantly older person prior to age 15.<ref name=briere1988>Briere, J., & Runtz, M. (1988). ''Symptomatology associated with childhood sexual victimization in a non-clinical adult sample''. Child Abuse & Neglect: The International Journal, 12, 51-59.</ref> Another non-clinical study by the same authors found that a history of childhood sexual abuse and especially a history of childhood physical abuse were predictive of dissociative symptoms, though they stated that the validity of the scale used to measure these symptoms was yet to be proven.<ref>Briere, J., & Runtz, M. (1990). "Augmenting Hopkins SCL scales to measure dissociative symptoms: Data from two nonclinical samples," ''Journal of Personality Assessment'', 55, 376–379.</ref> The level of dissociation has been found to be related to reported overwhelming sexual and physical abuse.<ref name=draijer>{{cite journal |last=Draijer |first=N |coauthors=Langeland W |year=1999 |month=March |title=Childhood trauma and perceived parental dysfunction in the etiology of dissociative symptoms in psychiatric inpatients |journal=Am J Psychiatry |volume=156 |issue=3 |pages=379–85 |pmid = 10080552 |accessdate= 2008-01-16}}</ref> When severe sexual abuse (penetration, several perpetrators, lasting more than one year) had occurred, dissociative symptoms were even more prominent.<ref name=draijer/> The amount of dissociation that follows directly after a trauma predicts [[posttraumatic stress disorder]] (PTSD).<ref name=Brown/> Individuals that are more likely to dissociate during a traumatic event are considerably more likely to develop chronic PTSD. <ref name=Brown/> One study found that subjects who experienced early and/or recent trauma were more dissociative <ref name=Pearson1991>{{cite journal | author = Pearson, M.L. | year = 1991 |journal=Dissociation |volume=10 |issue=1 |pages=58–62: | title =Childhood trauma, adult trauma, and dissociation | url = https://scholarsbank.uoregon.edu/dspace/bitstream/1794/1837/1/Diss_10_1_9_OCR.pdf |accessdate = 2008-05-20}}</ref> In a review of clinical literature, Merckelbach and Muris (2001) argue that a causal link between trauma and dissociation has not been established and may not be true, due what they describe as "at best, modest" correlations in the literature, possibly obscured results due to uncontrolled confounding variables, and possible positive bias towards self-reports of trauma resulting due to symptoms of dissociation. <ref name="merckelback">{{cite journal | author = Merckelbach H, Muris P | title = The causal link between self-reported trauma and dissociation: a critical review | journal = Behav Res Ther | volume = 39 | issue = 3 | pages = 245–54 | year = 2001 | month = March | pmid = 11227807 | doi = | url = http://linkinghub.elsevier.com/retrieve/pii/S0005-7967(99)00181-3 | accessdate = 2008-05-13}}</ref> Fantasy proneness, which is itself linked to self-reported abuse, is at least as predictive of measured dissociation as self-reported trauma.<ref>Pekala, Ronald J. (2001) "The importance of fantasy-proneness in dissociation: a replication," ''Contemporary Hypnosis'', 18(4), 204-214.</ref><ref>Pekala, Ronald J.; Kumar, V. K.; Ainslie, George; Elliott, Nancy C.; Mullen, Karen J.; Salinger, Margaret M.; Masten, Ellsworth (1999-2000). "Dissociation as a function of child abuse and fantasy proneness in a substance abuse population," ''Imagination, Cognition and Personality'', 19(2), 105-129.</ref><ref>Merckelbach, Harald and Jelicic, Marko (2004). "Dissociative symptoms are related to endorsement of the vague trauma items," ''Comprehensive Psychiatry'', 70-75.</ref> Merckelbach et al. (2004) questions the accuracy of self-reports of trauma by fantasy prone individuals, pointing to studies that found fantasy proneness to be related to overendorsement of implausible answers in surveys.<ref>Merckelbach, H., à Campo, J., Hardy, S., Giesbrecht, T. (2005). "Dissociation and fantasy proneness in psychiatric patients: A preliminary study," ''Comprehensive Psychiatry'', 46(3), 181-185.</ref> ==Psychoactive substances== [[Psychoactive]] substances can often induce a state of temporary dissociation. Substances with dissociative properties include [[ketamine]], [[nitrous oxide]], [[tiletamine]], [[dextromethorphan|DXM]], [[Cannabis (drug)|cannabis]], and [[phencyclidine|PCP]]. == See also == * [[Altered state of consciousness]] * [[Emotional detachment]] * [[Splitting (psychology)]] == References == {{reflist}} ==External links== * [https://scholarsbank.uoregon.edu/dspace/handle/1794/1129 The official journal of the International Society for the Study of Dissociation (ISSD), published between 1988 and 1997] * [http://boundless.uoregon.edu/digcol/diss/index.html Dissociation and Trauma Archives - Full text searchable articles and case studies published in the 1800s and early 1900s.] [[Category:Abnormal psychology]] [[Category:Dissociative disorders]] [[Category:Defence mechanism]] [[de:Dissoziation (Psychologie)]] [[es:Disociación (psicología)]] [[it:Dissociazione (psicologia)]] [[nl:Dissociatie (psychologie)]] [[ja:解離 (心理学)]] [[pl:Dysocjacja (psychologia)]] [[pt:Dissociação (psicologia)]] [[fi:Dissosiaatio (psykologia)]]