Journal of Trauma & Dissociation最新文献

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.

Therapeutic play is a foundational discovery from psychoanalysis and is now a major contribution to child treatment in all its forms. Underacknowledged derivatives from child's play in adult treatments include: the attention to principles of development; the application of nonverbal relational process; utilization of somatic movement; and above all, the therapeutic engagement with child self-states in the full spectrum of dissociative disorders. This case report describes psychoanalytic play with a therapist/analyst who is schooled in principles of trauma treatment and its dissociative manifestations as well as principles of dyadic, countertransferential attentiveness. The treatment mode - child psychoanalysis - allows for a natural integration of other forms of trauma work while still following the child, in all the twists and turns that her treatment illustrates and which both adult and child psychoanalysis privilege so uniquely.

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.

This paper examines the relationship between psychoanalysis and trauma, focusing specifically on dissociation-and, more narrowly, on dissociative multiplicity, the most challenging form for psychoanalysis to address. Dissociative multiplicity involves the presence of more than one center of consciousness, more than one "I," a feature of multiple personality, now called Dissociative Identity Disorder or DID, and OSDD-1, or subthreshold DID. The central question is whether classic psychoanalytic constructs, such as splitting, repression, various triadic views (oedipal, topographic, structural, Fairbairnian, Kohutian), object relations, and attachment theory, can adequately account for dissociative multiplicity. I explain how they cannot, but also how they remain applicable to multiplicity. I conclude with a summary view and reflection on what still needs to occur to reintegrate dissociation into mainstream psychoanalytic theory and practice.

Sandor Ferenczi contributed some of the best formulations of complex trauma and dissociation that exist. No one has described more passionately than Ferenczi the traumatic induction of dissociative trance with its resulting fragmentation of the personality. His concept of identification with the aggressor (which differed significantly from Anna Freud's later concept using the same term) describes how the traumatized child splits/dissociates the perpetrating aspects from the nurturing aspects of the aggressor and internalizes these in separate self-states, enabling the traumatically overwhelmed child to maintain a bond of tenderness with the aggressor. This article applies Ferenczi's concept of identification with the aggressor, along with some of Freud's and Bion's concepts of group dynamics, to the bond with and appeal of authoritarian leaders to their followers. Here, we find both dissociated parts that Ferenczi described operating in tandem, involving an idealization of the aggressor simultaneous with the enactment of aggressor-identified parts.

This study explores the relationship between maladaptive daydreaming (MD) and identity shame among individuals with MD. Participants described how MD originated or intensified during periods of distress related to aspects of their identity they felt shame toward, such as sexuality, culture, or disability. They constructed idealized versions of themselves in fantasies and imaginary communities, which provided them with belonging and acceptance. These fantasies seemed to allow participants to process shame without external support. The obsessive nature of MD narratives suggests participants were trapped in an incomplete emotional processing loop. Identity shame may be a core driver in some cases of MD, with fantasies serving as maladaptive coping when authentic identity expression is impeded. We utilized psychoanalytic concepts of projection and dissociation to provide a framework for understanding MD rooted in identity issues.

Transgender and nonbinary (i.e. trans) people commonly report dissociation as a survival strategy in hostile sociopolitical contexts, and initial studies have identified childhood trauma, transphobic marginalization, and gender incongruence as potential predictors of trans dissociation. However, more research is needed to establish transtheoretical explanatory factors using an intersectional lens. We thus sought to use an intracategorical complexity intersectional approach to assess whether social categories, general factors (i.e. childhood trauma, fantasy proneness, cognitive failures, sleep disturbance), and trans-specific factors (i.e. transphobic marginalization, gender congruence, gender dysphoria) would be related to dissociation. A cross-sectional online survey was administered to N = 203 trans adults who were diverse in gender, sexuality, SES, disability status, age, and state of residence, but were mostly White (73.4%). More frequent dissociation among trans men, nonbinary, gender non-conforming, younger, lower-SES, and disabled participants suggests important intersections of cissexism with classism and ableism. All general and trans-specific factors were significantly correlated with dissociation at the bivariate level, except for a non-significant trend with gender congruence; general factors explained additional variance in dissociation above social categories, but trans-specific factors did not. More research is needed to explore interactions of general and trans-specific factors, intersectional marginalization, temporal distinctions, and direct assessment of the unique gender dissociation identified in prior qualitative studies. The current findings may inform decolonized, affirming, intersectional marginalization trauma-informed mental health care, as well as social justice advocacy to reduce exposure to childhood trauma and transphobic marginalization in the current sociopolitical climate.

Dissociative Identity Disorder (DID) is increasingly depicted on popular online platforms such as TikTok. The present study aimed to analyze the portrayal of DID symptoms on TikTok, by comparing the frequency of clinical DID symptoms displayed in these videos to clinical data. Five popular DID-related hashtags were identified and a sample of 55 videos per hashtag were randomly selected to be analyzed (N = 249). Video engagement metrics and content-creator descriptives were gathered, and the core clinical symptoms of DID were assessed based on the Multidimensional Inventory of Dissociation (MID). The frequencies of DID symptoms in the TikTok videos were compared to a sample of 41 patients with a DID diagnosis clinically confirmed by the SCID-D-R (Dell, 2006). Results showed that most content was produced by creators with unknown credentials, and very few videos were from mental health professionals. Memory problems (amnesia) were the most frequently reported symptom in both samples, however no other symptoms occurred at the same relative frequency. In the DID-related TikTok videos all symptoms apart from amnesia were presented at <10% frequency, compared to having >75% occurrence in the clinical sample. The representation of DID on TikTok is not fully representative of clinical data and does not cover the full scope of clinical DID symptoms.