Who is who in dissociation?: A plea for psychodynamics in a time of trauma1

Contemporary theories of dissociation and trauma for the most part have evolved outside of psychoanalysis. Psychoanalytic writings have also been regarded as being in opposition to trauma‐based notions of human psychopathology. The specific psychoanalytic contribution—the emphasis on unconscious conflict and meaning—is for the most part excluded from the discourse on dissociation, often resulting in a mechanic conceptualisation of trauma. In this paper, based on clinical material, the author argues in favour of including conflict, unconscious intention and personal meaning in understanding the kind of dissociation we see in cases of multiple personality pathology. Textual analysis of letters written to the analyst illustrates how events of abuse are defensively elaborated. The author demonstrates that patterns of affect regulation and dominant object–relational strategies can be captured through analysis of the discourse structure. She focuses on how an organised character pattern, revealed mainly through narrative style and the analyst's countertransference, serves protective purposes as well as wishfulfillment. She argues that dissociation in the form of multiple personalities may imply an active, strategic agent.     

From “It's Not Me” to “It Was Me,After All”: A Case Presentation of a Patient Diagnosed with Dissociative Identity Disorder

In cases of extreme childhood trauma associated with abuse and neglect, one's sense of self is seriously compromised. Attachment patterns, symptoms, defensive operations, and character formation will differ depending upon the level of interference and impingement. When repeated trauma occurs in early childhood, the dissociative response may become the first line of defense for the person to rely upon. In its most severe form, patients are diagnosed with Dissociative Identity Disorder (DID). This paper addresses the case of a woman diagnosed with DID. It describes the restoration of a cohesive sense of self from the eight parts of a dissociated and fragmented self in the course of therapy. The clinical case material presented is that of the child part of her, known as Lucy. Her treatment resulted in the integration of the “it's not me!” self to the patient's knowledge that “it was me, after all.”     

Art-Making and its Interface With Dissociative Identity Disorder: No Words That Didn’t fit

Studies point to promising developments in expressive arts therapy work with clients who experience dissociation as one of a constellation of symptoms of trauma. Individuals diagnosed with Dissociative Identity Disorder, however, may be hesitant to engage with long-term therapy and its relationship. This article presents the case of one such individual, a participant in a narrative phenomenological study who was able to develop her own visual art-making practice. Reflections on this practice revealed that it offered a safe place for her to explore the voice of her “parts” hitherto silenced. Her narrative has implications for professionals working in the expressive and talking therapies.     

A pilot randomised controlled trial of a home-based writing intervention for individuals with seizures

Objective: We investigated the feasibility, acceptability and preliminary effectiveness of a writing intervention for individuals with epilepsy or psychogenic nonepileptic seizures.

Methods: Individuals were randomised to write about potentially ‘therapeutic’ topics (n = 43) or about their daily events (n = 25). Participants were asked to write on four separate occasions for at least 20 min. Repeated-measures analysis of variance was used to investigate change in measures of health-related quality of life (NEWQoL-6D), depression (NDDI-E), anxiety (GAD-7) and illness perception (B-IPQ) from baseline to one and three-month follow-ups. Qualitative and quantitative data taken from a Writing Task Questionnaire was analysed between the two conditions.

Results: Recruitment was acceptable with 52% of those randomised completing the full writing intervention. In both conditions, participants wrote for longer than 20 min suggesting those who completed the study engaged well with the procedure. Greater benefits were observed in the ‘therapeutic’ condition (p < 0.05), which was associated with an improvement in health-related quality of life at one-month follow-up (p = 0.02). No differences were found in the other measures.

Conclusions: A writing intervention is acceptable in this population. Self-reported benefits were modest, suggesting therapeutic writing may be more suitable as a supplement to other therapies rather than a stand-alone therapeutic intervention.     

消费者何时愿意选择与规避群体关联的品牌?

消费者何时愿意选择与规避群体关联的品牌?规避群体对消费者的影响机制还需要进一步研究。基于心理逆反理论, 本文通过3个实验探讨自由威胁对消费者选择与规避群体关联的品牌的影响。结果发现, 当消费者感知到高自由威胁时, 选择与规避群体关联的品牌的意愿较高, 心理逆反发挥中介作用, 叙事和自尊水平对上述影响关系具有调节作用。叙事性的信息使得被试因自由威胁所产生的心理逆反降低, 从而对与规避群体关联的品牌的选择意愿降低。对于高自尊的个体, 在高自由威胁时更愿意选择与规避群体关联的品牌; 而对于低自尊的个体, 在高/低自由威胁情况下对规避群体关联的品牌的偏好无显著差异。本文探讨了自由威胁对消费者品牌偏好的影响, 丰富了规避群体和品牌选择的研究; 验证了心理逆反在自由威胁与规避群体关联品牌偏好之间的中介作用, 深化了心理逆反理论。本文对企业在保留现有客户群的基础上, 如何吸引外群体消费者具有一定的指导价值。     

Cognitive Processing Therapy for Concurrent Posttraumatic Stress Disorder and Psychogenic Nonepileptic Seizures: A Case Study

Psychogenic nonepileptic seizures (PNES) are the number-one medically unexplained symptom encountered by neurologists (Brown & Reuber, 2016) and account for approximately 30% of patients referred to epilepsy centers (Leu et al., 2020). Episodes of PNES physically resemble epileptic seizures; however, electrical activity within the brain appears to be within normal limits. Currently, there are no medications available to specifically manage PNES (Hingray et al., 2017). Although studies focused on the impact of psychological interventions for PNES are limited, cognitive behavioral therapy (CBT) approaches appear to be effective (LaFrance et al., 2014). Prior exposure to a traumatic event is common for patients with PNES (Brown & Reuber, 2016; Myers et al., 2017). Cognitive Processing Therapy (CPT) is an evidence-based psychotherapy for posttraumatic stress disorder (PTSD). CPT is effective for a variety of traumatic experiences, and asks patients to address avoidance (e.g., of situations, emotions) and challenge maladaptive thought patterns (Resick et al., 2017). In this case study, a 29-year-old Caucasian female patient presented for treatment with comorbid PTSD and PNES. Current PTSD diagnosis was indicated by self-reported and clinician-administered assessment, which included the Clinician Administered PTSD Scale for DSM-5 (CAPS-5 = 52 out of 80) and the PTSD Checklist for DSM-5 (PCL-5 = 59 out of 80). This patient’s Criterion A trauma involved repeated domestic sexual assault as an adult, which occurred for several years. PNES was diagnosed approximately 1 year prior by a neuropsychologist. At the start of treatment, the patient endorsed PNES almost daily, which prevented her from maintaining a job or driving a vehicle. The patient was an early and successful responder to CPT, as she participated in 8 of 12 sessions. In addition to significantly lower self-reported PTSD and depressive symptom severity (PCL-5 = 5; PHQ-9 = 2), she did not experience PNES in the 17 days leading up to her final session. As the patient’s avoidance of distressing trauma-related thoughts and emotions decreased, so too did her PNES. This case study provides neurologists with a promising treatment approach for patients with PNES and PTSD.     

认知还是元认知：口语产生中舌尖效应的心理机制

舌尖效应(Tip-of-the-tongue, TOT)在口语产生领域存在认知和元认知两种研究视角。认知视角主要针对口语产生的词汇通达过程, 认为信息激活或提取不充分是TOT发生的主要原因。元认知视角则主要关注口语产生的元认知过程, 认为个体对目标词提取状态的监测引发了TOT。TOT的元认知过程不仅可以监测目标词的提取状态及词汇通达过程中相关信息的提取, 而且可以控制词汇通达过程, 使目标词在TOT发生后成功地提取出来。两种研究视角在TOT发生的认知机制、影响因素以及生理基础方面均存在分离。未来研究应该探讨TOT监测和控制口语产生的作用机制和生理基础, 关注汉语背景下TOT发生规律及其对口语产生年老化的积极影响。     

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.     

BRAIN, SYMBOL, & EXPERIENCE: A PSYCHIATRIC AND THEOLOGICAL DIALOGUE

Abstract. Brain, Symbol & Experience attempts to solidify the authors' work in the fields of neurophenomenology and consciousness. The interdisciplinary nature of the work dictates less than extensive discussions of individual academic topics, but it does facilitate the identification of mutual points of interest for future pluralistic dialogues. This paper explores the implications of Laughlin, McManus, and d'Aquili for the neurosciences, psycho-pathology, psychotherapy, contemporary literature, theology, and faith development theory. Suggestions for specific interdisciplinary conversations are offered.