Journal of Trauma & Dissociation最新文献

Recent research highlights heterogeneity in habitual emotion regulation repertoires individuals use to cope with daily life events. These emotion regulation profiles, identified in the general population, have been proposed as potential mediators of various psychological conditions, including trait dissociation. However, their individual determinants remain unclear. This study examined the role of trait emotional reactivity in predicting emotion regulation profiles and the mediating effect of these profiles on trait dissociation. A sample of 302 participants completed an online assessment measuring emotional reactivity, emotion regulation strategies, and dissociative tendencies. Latent profile analysis identified five distinct emotion regulation profiles: high and low regulation, one adaptive, and two maladaptive profiles. Trait emotional reactivity strongly predicted membership to these profiles. Crucially, emotion regulation profiles mediated the relationship between emotional reactivity and dissociation, with specific maladaptive profiles amplifying this association. These findings indicate that dispositional emotional traits influence which emotion regulation strategies people habitually use. Moreover, emotion regulation profiles may serve as pathways through which heightened emotional reactivity contributes to dissociative symptoms. Understanding these mechanisms provides novel insights into how individual differences in emotion regulation contribute to psychological well-being.

Sexual assault has been repeatedly associated with multiple types of psychological distress, including posttraumatic stress. Post-assault outcomes are frequently linked to individual psychological processes (e.g. cognitions, behaviors) that are targeted in common psychotherapies, yet contextual factors (e.g. relationships, institutional factors) also play important roles in distress. Using a socioecological approach, this study examined how contextual factors such as institutional betrayal cross-sectionally predict posttraumatic stress in a sample of campus sexual assault survivors who enrolled at a large, public university in the Pacific Northwest of the United States and who disclosed their assault to another person (N = 245). Results indicated that multiple contextual factors outside of the individual (e.g. relationship with perpetrator, reactions to disclosure, institutional betrayal) were significantly associated with posttraumatic stress (r's = .27-.51) and explained significant unique variance in posttraumatic stress in regression analyses. These associations remained even after controlling for self-blame cognitions and avoidance coping behaviors - two individual-level factors frequently addressed by evidence-based treatments for posttraumatic stress. Such results highlight a need for psychological and public health interventions that target higher levels of the social ecology, such as relational or institutional interventions.

Dissociative identity disorder (DID) is a childhood-onset posttraumatic biopsychosocial syndrome characterized by identity alteration symptoms in which one loses a sense of agency and ownership over some thoughts, feelings, memories, and behaviors. There is limited investigation of sociodemographic variability related to DID prevalence. Further, there is limited assessment of symptoms in non-clinical samples that may shed light on potential dissociative phenotypes in the general population. We utilized a large citizen science online data collection platform to collect self-report symptoms of dissociative identity disorder among self-selected adults in the general population. Participants (N = 5,589) provided demographic information and completed the Multiscale Dissociation Inventory self-report assessment (MDI). We completed general linear models to investigate associations between race, gender, and geographic location with a provisional self-report DID diagnosis and MDI identity dissociation scores. In general, individuals from marginalized racial groups had higher provisional DID prevalence rates and more severe identity dissociation symptoms compared to White individuals. Genderqueer individuals reported higher rates of provisional DID compared to men and women, and men reported higher rates compared to women. We also observed significant differences in the prevalence of DID symptoms across geographic regions. These novel results suggest that race, gender, and geographic location are linked to variation in rates of provisional DID diagnosis and identity alteration symptom severity. Marginalized groups with potentially the highest rates of DID are underrepresented in current research. Future work should explore contributing factors to these sociodemographic differences to develop effective prevention and treatment strategies for specific groups.

Contemporary approaches to trauma tend to minimize or even overlook a psychodynamic perspective to treatment. The challenge for the clinician is sensing when such interventions might help or hurt. This chapter illustrates this dilemma by drawing upon the author's experience, both personal and professional, in arriving at some basic principles. The synthesis of his experience on an inpatient dissociative disorders unit with his long-term analytic work in the outpatient setting is a treatment model, Psychoactive Psychotherapy. It is a six stage, transference-based approach, addressing the autohypnotic nature of dissociation as a defense. Integration of the compartmentalized self-states (alters) is facilitated through the delineation of the "mosaic transference" and the therapist's capacity for containment.

Sándor Ferenczi's contribution recognizes the relevant interpersonal aspects and intersubjective dialogue as central to psychoanalytic theory and clinical practice. Through his theoretical, clinical and technical studies, he has developed numerous notions in relation to trauma, the effects of its disavowal and its impact exceeding the victim's capacity for understanding and symbolization. After about 50 years of forced oblivion, Ferenczi's thought has regained full recognition since 1990s among the wider psychoanalytic and clinical community in general. Authors analyze Ferenczi's fundamental intuitions on the "confusion of tongues" and trauma, dissociative, and defensive processes, understood as a dysfunctional interpersonal process that undermines the capacity to make sense of experience. Consequently, healing can only occur through new and functional relational experiences within a sincere and affective therapeutic relationship. The latter, moreover, is seen as an exercise in reflective thinking in the form of participatory dialogue that helps the patient to develop, trust, reflective capacity and to integrate his personality.

The Guest Editors provide an overview of the papers appearing in this issue of the Journal of Trauma and Dissociation. Freud's opus with its emphasis on fantasy while appreciated as a vital contribution to the establishment of psychoanalysis, essentially "dissociates" the effect of exogenous trauma on the dissociative structure of the mind. The Guest Editors argue that the papers in the current issue support the idea that exogenous trauma and the resulting dissociative structuring of the mind play a significant role in the development of psychopathology.

Freud's instinct theory and Bowlby's attachment theory are generally seen as oppositional approaches. Most crucially, the two theories sharply differ on the question of internal vs. external origins of trauma: whether trauma originates from intra-psychic conflict between innate instincts (Freud), or from various degrees of relational deficiencies in the attachment figure's attentiveness and subsequent protection of the child from actual harm (Bowlby). This disagreement is often deemed completely unbridgeable. This paper, however, views the two theories as two links in a lineage of ideas rather than two opposites, as it follows the gradual shift of psychoanalytic emphasis from innate instincts to external objects; through objects to the Self; and from phantasy relationship to the crucial impact of actual relationships.

The author addresses how psychoanalysts sometimes create theories enabling the treatment of conditions which they themselves fail to acknowledge. When working with trauma clinicians are subject to disavowal, denial, detachment, and/or dissociation. Papers by Bion, Bowlby, and Freud are discussed for their clinical interest and how their theories prevented them from making use of their own ideas. Bion's outlining of the impact of hierarchy and conformity aids trauma work and its connection to whistleblowing although he didn't discuss child abuse. Bowlby regretted avoiding child abuse yet his work on attachment and loss benefits trauma workers. Freud's avoidance of externality such as socio-political embedded ideas on family and class prevented him from addressing the impact of reality on the structuring of mind. The author identifies examples from her own work illustrating where internalized theory aided her work with patients and where the impact of patients' trauma prevented her from using the tools at her disposal.

The author discusses the break interpersonalists made with Freud's drive, defense, fantasy model by shifting the focus of inquiry to what occurs between people creates mind while retaining Freud's concepts of transference, countertransference, dream interpretation and the unconscious. Additionally, they acknowledged influences from culture, class, and religion as contributing factors to the organization of family structure and individual minds. The relational school bifurcated psychoanalytic theory into the drive structure model (Freudian theory, Ego Psychology), and the relational structure model (interpersonal school, British Object Relations, and SelfPsychology). Its strength lies in its recognition that interactions in the interpersonal world effects the formation of mind along with object relations theory emphasizing that intrapsychic structure influences perceptions and interactions in the relational world. Since both schools of thought acknowledge Sandor Ferenczi as their progenitor, a brief discussion of his influential contributions is offered.