Pathological Dissociation and Its Relationships with Aggression and Delinquency in a College Student Sample in Hong Kong

Pathological dissociation is widely regarded as a cross-culturally occurring condition related to trauma and adversity and is an important construct in the mental health field. Yet, the frequency of pathological dissociation in both clinical and nonclinical populations in Hong Kong remains unknown. In addition, the relationship of pathological dissociation with aggression and delinquency requires further investigation. To investigate these relationships, we administered the Dissociative Experiences Scale-Taxon (DES-T), the 5-item Somatoform Dissociation Questionnaire (SDQ-5), selected sections from the Self-Report Version of the Dissociative Disorders Interview Schedule (SR-DDIS), the Reactive–Proactive Aggression Questionnaire (RPQ), and a delinquent behaviors checklist to 177 college students in Hong Kong. The findings suggest that pathological dissociation is not as rare as it is traditionally believed to be in Hong Kong. In our sample, 4.52% of the participants may have a DSM-5 dissociative disorder (including other specified dissociative disorder) while 9.60% met the DSM-5 diagnostic criteria for borderline personality disorder (BPD). Our findings indicate that the RPQ total score and delinquency may be more characteristic of BPD than of pathological dissociation. In addition, while reactive aggression was related to pathological dissociation and BPD symptoms in both genders, proactive aggression was related to pathological dissociation and BPD symptoms only in females. Although the findings of this study are preliminary and the results should be interpreted with caution, the study provides the first data regarding pathological dissociation and its relationship with aggression and delinquency in Hong Kong. Some implications for research and practice are highlighted. Further investigation of pathological dissociation in Hong Kong is necessary. In addition, more studies are essential to further examine the relationships between pathological dissociation, aggression, and delinquency in both clinical and nonclinical populations.     

Psychotic symptoms in posttraumatic stress disorder

Recent data suggest that the presence of psychotic symptoms in patients suffering from posttraumatic stress disorder (PTSD) may represent an underrecognized and unique subtype of PTSD. Among combat veterans with PTSD, 30% to 40% report auditory or visual hallucinations and/or delusions. The presence of psychotic symptoms in PTSD is associated with a more severe level of psychopathology, similar to that of chronic schizophrenia. In this review, the differential diagnosis of psychotic symptoms in PTSD is discussed, including possible comorbid schizophrenia, psychotic depression, substance-induced psychosis, and personality disorder. A recent biologic study supporting the existence of a unique subtype of PTSD with psychotic features is also addressed, as are the similarities between PTSD with psychotic features and psychotic depression disorder. Finally, data on the treatment implications of psychotic symptoms in PTSD are presented. The intriguing recent findings on psychotic symptoms in PTSD need further investigation in noncombat-related PTSD populations before findings can be generalized to all individuals with PTSD.     

Psychometric Comparison of Dissociative Experiences Scales II and C: A Weak Trauma‐Dissociation Link

The debate regarding the relationship between dissociation and trauma has raised questions regarding the validity of measures of dissociation. Dalenberg et al.'s ( 2012 ) meta‐analysis included studies using the Dissociative Experiences Scale (DES II), but excluded the DES‐Comparison (DES‐C) scale, claiming that it lacked validity as a measure of dissociation. Lynn et al. ( 2014 ) contended that omitting those studies might have skewed the results. In the current study, we compared the psychometric properties of both measures in two nonclinical US adult (student, general population) samples to evaluate the convergent and discriminant validity of the scales. We found support for the DES‐II as a measure of dissociation as well as the validity and reliability of the DES‐C, which compares well to the DES II. Compared with studies in Dalenberg et al., we found lower correlations between trauma and dissociation. No empirical basis exists to exclude studies using the DES‐C in literature reviews. Copyright © 2017 John Wiley & Sons, Ltd.     

Insult,then Injury: Interpersonal and Institutional Betrayal Linked to Health and Dissociation

Psychological trauma, particularly trauma involving betrayal, has been linked to health problems. Betrayal trauma is also characterized by dissociation and difficulty remembering as victims face conflicting demands presented by a harmful but important relationship. Institutional betrayal is related to, but distinct from, interpersonal betrayal and in need of research on its unique effects. The current study has two related goals. First, the association between institutional betrayal and health problems is examined. Second, the previously documented association between institutional betrayal and dissociative symptoms is re-examined, while controlling for betrayal trauma. This study utilizes a sample of 302 college students (70% female, 63% Caucasian) who reported their trauma history (Brief Betrayal Trauma Survey), institutional betrayal history (Institutional Betrayal Questionnaire), distress related to health problems (Patient Health Questionnaire), and dissociative symptoms (Wessex Dissociation Scale). We found that institutional betrayal is uniquely associated with both health problems and dissociative symptoms even when controlling for betrayal trauma exposure. Findings add to the understanding of how institutional betrayal is uniquely associated to trauma-related physical and mental health outcomes. Small effect sizes, likely due to low base rates of health problems and dissociative symptoms in college students, and problems generalizing these results to clinical samples are discussed.     

Autobiographical memory for trauma: update on four controversies

Empirical research since the year 2000 on trauma and autobiographical memory in adults is reviewed and related to four enduring controversies in the field: Whether traumatic memories are inherently different from other types of autobiographical memory; whether memory for trauma is better or worse than memory for non-traumatic events; whether traumas can be forgotten and then recalled later in life; and whether special mechanisms such as repression or dissociation are required to account for any such forgetting. The review concludes that trauma and non-trauma memories differ substantially, but only in clinical and not in healthy populations. Whereas involuntary memory is enhanced in clinical populations, voluntary memory is likely to be fragmented, disorganised, and incomplete. Progress in experimental and neuroimaging research will depend on analysing how task performance is affected by the interaction of voluntary and involuntary memory and by individual tendencies to respond to trauma with increased arousal versus dissociation.     

Measuring dissociation: comparison of alternative forms of the dissociative experiences scale

The dissociative experiences scale (DES), developed by Bernstein and Putnam (1986), is commonly used to measure dissociation in clinical populations. It is often used with nonclinical populations to assess how levels of dissociation covary with other psychometric measures. When it is used with nonclinical populations, problems arise because the resulting scores can show severe floor effects and often are highly skewed. To remedy these problems, we developed alternative ways of measuring self-reported dissociative experiences. A form of the DES in which people were required to rate how often they have each of 28 experiences compared with other people was superior in avoiding problems of floor effects and skewness. We discuss situations in which this alternative, which we call DES C, is preferred.     

“Where Are You?” Defensive Dissociation and Fragments of Annihilated Faith

This article addresses the relation between defensive dissociation and faith. Defensive dissociation is understood as a response to severe trauma. In this response there is no interpreting subject to process the event linguistically and the result is fragments of unformulated memory that continue to be painfully present long after the original trauma. The victim of severe trauma alternates between the need to be here in the presence of other human beings and the dissociative isolation of not being here. There are two related claims in this article. First, defensive dissociation stands for an event where faith is annihilated. As a defense it protects a person's remnant sense of faith, subjectivity, agency, and personhood by creating a space of non-experience. Fragments of annihilated faith continue to be present in the person's present formulations of faith and concomitant behaviors, relationships, and use of objects. The second claim is that the core of severe trauma remains outside the victim and community's capacities to represent it symbolically. This incommunicable core of annihilated faith can be contained by a community of faithful persons who are willing to face the horror of non-being and being nowhere without succumbing to despair.     

Dissociation and memory fragmentation in post-traumatic stress disorder: an evaluation of the dissociative encoding hypothesis

Several prominent theories of post-traumatic stress disorder (PTSD) posit that peritraumatic dissociation results in insufficient encoding of the trauma memory and that persistent dissociation prevents memory elaboration, resulting in memory fragmentation and PTSD. In this review we summarise the empirical literature on peritraumatic and trait dissociation and trauma narrative fragmentation as measured by meta-memory and rater/objective coding. Across 16 studies to date, the association between dissociation and fragmentation was most prominent when examining peritraumatic dissociation and patient's own ratings of memory fragmentation. This relationship did not hold when examining trait dissociation or rater-coded or computer-generated measures of fragmentation. Thus initial evidence points more towards a strong self-reported association between constructs that is not supported on more objective fragmentation coding. Measurement overlap, construct ambiguity, and exclusion of potential confounds may underlie lack of a strong association between dissociation and objective-rated fragmentation.     

Socio-economic status and the developing brain in adolescence: A systematic review

Socioeconomic status is associated with differences in social, cognitive, and behavioral outcomes for adolescents. Correspondingly, the period reflects continued dynamic, complex, and adaptive brain development. Research demonstrates associations between the developing adolescent brain and SES; however, such research has not been systematically integrated. We undertook a systematic search of studies and review 21 papers that examined both SES and brain development or functioning as measured during adolescence or young adulthood in nonclinical populations (13–25 years old). Few studies focused on architecture and such findings were varied. The majority of studies focused on functioning with two themes emerging. First, studies demonstrate different activation in regions of interest to cognitive and behavioral tasks relative to SES. Second, when similar neurological activation is evident, they can be related to different behavioral observations relative to SES. There is also evidence of different neurological functioning associated with SES with regard to different conceptualizations and coding of SES. Further, some of the reviewed studies identified potential mediators to the relationship, such as parenting practices, stress, and IQ. Overall, the findings suggest it is important to consider SES and neighborhood context within neuroscience research and practice.     

The search for dimensional structure differences between normality and abnormality: a statistical review of published data on personality and psychopathology

A statistical review of published data for 37 personality and psychopathology inventories was conducted to determine whether there are dimensional structure differences between clinical and nonclinical respondents. Correlation and factor-loading matrices from multiscale inventories and from specialized measures were tested for structural invariance across populations. There was relatively consistent evidence for high levels of similarity between normal and abnormal populations both in the number of factors that exist in the data matrices and in the factor patterns. The dimensional universes of normality and abnormality are apparently the same, at least according to data derived from contemporary assessment instruments. Categorical-taxonic differences between clinical and nonclinical populations, which were not examined, may nevertheless exist within contexts of dimensional structure similarity.     

Refining our understanding of the VIA Classification: Reflections on papers by Han,Miller, and Snow

ABSTRACT

Han, Miller, and Snow have written three thoughtful critiques of the VIA Classification of Strengths and Virtues. In this response, I emphasize five points. First, I suggest the concept of practical wisdom may be understood in terms of three VIA strengths: prudence, judgment, and perspective. Second, recognizing that the VIA Classification is a structural model of individual traits, rather than a moral theory, can address some concerns about the model, including its failure to account for the unity of the virtues. Third, I review a three-virtue model that has emerged in recent research on the VIA strengths may provide essential elements for a taxonomy of virtue. Fourth, I raise several issues associated with the application of the VIA Classification to moral education. Finally, though the model demonstrates substantial generalizabilty across Westernized populations, research in traditional indigenous cultures remains insufficient. I conclude with a series of questions for future research.     

The relationship between bullying, psychotic-like experiences and appraisals in 14-16-year olds

The psychological consequences of bullying have been the focus of much research over the last 25 years. However, the relationship between bullying and psychotic experiences has been relatively ignored despite the weight of evidence which suggests that traumatic events in childhood are significantly related to psychotic disorders. 373 pupils aged between 14 and 16 years took part in the study. They were asked to complete a number of self-report measures which examined their experience of bullying, predisposition to auditory hallucinations, paranoia and dissociation, and beliefs about both the self and the world and about paranoia. It was found that bullying was significantly associated with predisposition to psychotic experiences. Negative post-trauma cognitions were also associated with predisposition to psychotic phenomena as were positive beliefs about paranoia. Being bullied at school and beliefs about trauma and psychotic symptoms may contribute to the development of psychosis. However, it is also possible that these results indicate that experiencing psychotic-like phenomena increases the likelihood that a pupil's interpersonal context is characterised by peer hostility and rejection. The implications of these results are discussed.     

I Know That my Redeemer Lives: Relational Perspectives on Trauma, Dissociation, and Faith

This paper focuses the lens of multiplicity on patients’ religious experience in relation to the psychic realities of early or pervasive trauma, where dissociation is not just a normal means of self-regulation, but becomes an entrenched structuring mechanism through which the trauma survivor experiences every relationship, including any relationship to God. What might God or faith look like from the perspective of the traumatized self? This paper considers issues of multiplicity and dissociation as they affect the processing of religious or spiritual experience, with a few brief clinical illustrations, and offers a reading of the biblical book of Job as a metaphor for the inner world of the survivor of early trauma.     

Comparing premodern melancholy/mania and modern trauma: an argument in favor of historical experiences of trauma

Historians and psychiatrists have repeatedly looked to both real and imagined individuals of the past, like Achilles and Samuel Pepys, and found evidence that they were suffering from symptoms of trauma and posttraumatic stress disorder. The assumptions that allow such historical "diagnoses" have, however, recently been called into question by philosophers such as lan Hacking, anthropologists like Allan Young and psychiatrists such as Patrick Bracken. These scholars have all suggested in various ways that experiences of trauma could not have occurred until the diagnosis of trauma and its symptoms had been formalized and the language of trauma had been developed in the late 19th century. This article attempts to resolve this bifurcation of opinion on the universality of the mind and historical experiences of trauma in two ways. First, it argues for the necessity of applying modern categories of analysis to further present understandings of the past. Second, it considers discussions of"melancholia" and "mania" in premodern medical literature and argues that there are enough similarities between the causes and symptoms of these premodern disorders and modern trauma to suggest that experiences of trauma may not be wholly culturally bound to the modern world, as the above scholars have suggested. While melancholy or mania cannot simply be understood as premodern names for trauma, and it is not always correct to "diagnose" a premodern person who exhibits symptoms of these illnesses with trauma, such an assumption is not always ahistorical or incorrect either.     

Confirmatory factor analysis of single- and multiple-factor competing models of the dissociative experiences scale in a nonclinical sample

Previous research on the Dissociative Experiences Scale (DES) has demonstrated that (a) dissociation is quantifiable in both clinical and nonclinical samples and (b) a three-factor structure (amnesia, depersonalization, and absorption) is tenable for clinical samples. The factor structurefor nonclinical samples is less clear, with one- and multiple-factor solutions proposed. To clarify the DESfactor structure in nonclinical samples, confirmatory factor analyses were conducted on (a) one-, two-, three-, and four-factorfirst-order models and (b) two bifactor (hierarchical) models of DES scoresfor two samples of nonclinical university students. Results of delta(chi2) and goodness-of-fit indices support the three-factor (first-order) model as bestfitting of the datafor these samples. The utility of this DES model for screening both dissociative pathology and elevated normal dissociative behavior in clinical and nonclinical populations is discussed.     

Measuring Abuse Sequelae: Validating and Extending the Trauma Symptom Checklist–40

This study used the Trauma Symptom Checklist–40 (TSC–40) to index both childhood sexual abuse (CSA) and childhood physical abuse (CPA) in a college student sample of both men and women (N = 441). Although the TSC–40 was designed as a measure of CSA trauma, this study concludes the measure is appropriately reliable for indexing the traumatic sequelae of CPA as well as CSA in nonclinical samples. This study also explored the effects of gender and abuse severity on resulting symptomatology, finding that women and severely abused individuals report the most negative sequelae. Both CSA and CPA emerged as significant explanatory variables in TSC–40 scale scores beyond gender, supporting its validity for indexing traumatic sequelae in nonclinical samples.     

Extending the Negative Consequences of Media Internalization and Self-Objectification to Dissociation and Self-Harm

Self-objectification is often understood as a consequence of internalizing unrealistic media ideals. The consequences of self-objectification have been well studied and include depression and self-harm. We argue that body surveillance, a component of self-objectification that involves taking an observer’s perspective on oneself, is conceptually related to dissociation, a variable related to depression and self-harm. We hypothesized that the normative experience of self-objectification may increase the risk that young women dissociate in other contexts, providing an additional indirect path between self-objectification, depression, and self-harm. Snowball sampling begun with postings on Facebook was used to recruit 160 women, believed to be primarily from the U.S., to complete an online survey about the effects of media on young women. All participants ranged in age from 18–35 (M?=?23.12, Median?=?22, Mode?=?21). Using this sample, we tested a path model in which internalization of media ideals led to body surveillance and body shame, body surveillance led to dissociation and body shame, body shame and dissociation led to depression, and dissociation and depression led to self-harm. This model, in which we controlled for the effects of age, had good fit to the data. Our findings suggest that self-harm and dissociation, both outcomes associated with the literature on trauma, are related to self-objectification. These relationships are discussed in terms of conceptualizing objectification and self-objectification as a form of insidious trauma or microaggression. Clinical implications are also discussed.     

P50 sensory gating is related to performance on select tasks of cognitive inhibition

P50 suppression deficits have been documented in clinical and nonclinical populations, but the behavioral correlates of impaired auditory sensory gating remain poorly understood. In the present study, we examined the relationship between P50 gating and healthy adults’ performance on cognitive inhibition tasks. On the basis of load theory (Lavie, Hirst, de Fockert, & Viding, 2004), we predicted that a high perceptual load, a possible consequence of poor auditory P50 sensory gating, would have differential (i.e., positive vs. negative) effects on performance of cognitive inhibition tasks. A dissociation was observed such that P50 gating was negatively related to interference resolution on a Stroop task and positively related to response inhibition on a go/no-go task. Our findings support the idea that a high perceptual load may be beneficial to Stroop performance because of the reduced processing of distractors but detrimental to performance on the go/no-go task because of interference with stimulus discrimination.     

The symbolic and concrete: Psychotic adolescents in psychoanalytic psychotherapy

Unique disturbances in symbolisation are characteristic of the pathology of schizophrenia. Drawing on the case vignette of a psychotic adolescent, the author discusses theoretical problems in the symbolisation process in general and then in psychosis, in particular the relation between 'concretism' as a thought disorder and other psychotic defences. The ability to symbolise on the one hand and to maintain sufficiently stable ego boundaries on the other hand are examined in their relation. The author's clinical experience supports her hypothesis that there is a close relationship between the impairment of the symbolisation process in the adolescent or adult psychotic patient and his/her inability to engage in symbolic play as a child. Special attention is paid to the role of early trauma and consequent pathology of object relations for disturbances of symbolic play in childhood. Regression to concrete thinking is understood as the chance of the psychotic patient to give some meaning to reality in an unreal, delusional world and as his/her last chance to communicate at all. Conclusions are drawn for psychoanalytic techniques in the treatment of patients who are deeply regressed in this respect. Special attention is given to the particular circumstances and challenges of adolescence and to providing psychoanalytic psychotherapy to adolescent psychotic patients.     

The Traumatized Patient’s Word and Temperament as Elements of Successful Psychotherapeutic Treatment

I will review the case presentation by Ron Bodansky of two treatments of a primitively organized patient who endured childhood trauma. Drawing on the material, as well as work by Fairbairn and Verhaeghe, I offer two proposals to help explain why some deeply traumatized patients improve in psychotherapy. First, inborn temperament may be more important than the nature of the trauma or the specifics of the treatment itself. Second, the mitigating effect of the treatment may be found in the nature of the relationship between the therapist and patient. By abandoning assumptions regarding the patient’s prognosis, and by providing sustained attention to, and committed interest in, the patient’s stated experiences, all within a specifically therapeutic boundary, patients may develop the language and representation capacities needed to live beyond trauma, and thus be taken at their word.