Tyson D. Bailey, PsyD, ABPP
During my internship year, I sat in group supervision listening to the story of a person who had experienced horrific abuse coming to understand the effects of these repeated experiences over time. This client moved from a place of terror toward curiosity about their internal world and how dissociation helped protect them from the intensity of the abuse and their emotions. Listening to my colleague honor this survivor’s story while they came to know their parts and how each one has been integral in their survival was a powerful learning experience. Then, the person was admitted to a hospital where a psychiatrist stated “Dissociation is not real; your therapist is an idiot.” I will never forget the gut-wrenching feeling I experienced as a removed observer to this situation, which I can only imagine is a fraction of what the survivor experienced after this invalidation of their lived experience. I hope we move toward a time where such stories are talked about in the same manner as “there was a time when sticking ice picks in people’s brains was believed to be therapeutic,” where we can validate the amazing ways human physiology can adapt to egregious, repeated harm to body and self. It is toward this goal that I am honored to present Trauma Psychology News’ special section on dissociation.
This section begins with Bryan Reuther’s overview of dissociation and some of the difficulties we have experienced as a field creating a parsimonious definition. Paula Thomson provides a look into dissociative strategies utilized by athletes and performing artists, focusing on how these may help or hinder performance and development of self. In an exciting development for assessment of dissociation, Ana Abu and colleagues have constructed a validity scale for the Dissociative Experiences Scale that may be helpful for clinicians and researchers. From a treatment perspective, Hugo Schielke and colleagues provide information about the TOP DD studies, a series of studies about the treatment of living with dissociative disorders. Utilizing the phrase “it’s just a donut,” Lynne Harris discusses a case example of helping a client regulate her physiology and reduce the impact of dissociation on her daily functioning. Robert Stolorow’s article highlights psychoanalytic views on the effects of dissociation and how healing may be experienced. Finally, Charles Benincasa and I discuss the effects of invalidation experienced by many individuals who utilize dissociation to survive unspeakable horror. We then call on trauma psychologists to be unified in acknowledging the legitimacy of Dissociative Identity Disorder.
Trauma psychologists are in a unique position to validate dissociation—a neurobiological mechanism that can become problematic when circumstances require overreliance on this strategy (Frewen & Lanius, 2006a, 2006b; Liotti, 1992; Schore, 2009). Although authors continue to state dissociation is controversial, the research base verifying this experience across psychological and neurophysiological realms is becoming increasingly robust each year. In accordance with this research base, the proposed criteria for dissociative identity disorder in the International Classification of Diseases-11 (World Health Organization, 2018)removes any mention of controversy or being a culturally-bound experience from the diagnostic description. It was not so long ago that individuals who experienced symptoms after exposure to trauma were viewed as weak, otherwise deficient, or at worst, fabricating their symptoms for attention or other type of gain. The cultural shift toward recognizing the effects of trauma has provided validation that is not consistently extended to those living with one or more symptoms on the dissociative spectrum. Trauma psychologists have a long history of pushing the boundaries and fighting for an inclusive recognition of the widespread and potentially enduring effects of trauma across the lifespan; let’s not stop now.
References
Frewen, P. A., & Lanius, R. A. (2006a). Neurobiology of dissociation: Unity and disunity in mind-body-brain. Psychiatric Clinics of North America, 29(1), 113-128. Retrieved from doi:https://doi.org/10.1016/j.psc.2005.10.016
Frewen, P. A., & Lanius, R. A. (2006b). Toward a psychobiology of posttraumatic self-dysregulation: reexperiencing, hyperarousal, dissociation, and emotional numbing. Annals Of The New York Academy Of Sciences, 1071, 110-124. Retrieved from doi:https://doi.org/10.1196/annals.1364.010
Liotti, G. (1992). Disorganized/disoriented attachment in the etiology of the dissociative disorders. Dissociation: Progress in the Dissociative Disorders, 5(4), 196-204. Retrieved from http://hdl.handle.net/1794/1722.
Schore, A. (2009). Attachment trauma and the developing right brain: Origins of pathological dissociation. In P. F. Dell & J. A. O’Neil (Eds.), Dissociation and The Dissociative Disorders: DSM-V and Beyond(pp. 107-141). New York: Routledge/Taylor & Francis Group.
World Health Organization. (2018). ICD-11 for mortality and morbidity statistics, 6B64 dissociative identity disorder. Retrieved from https://icd.who.int/browse11/l-m/en#/http%3a%2f%2fid.who.int%2ficd%2fentity%2f1829103493
