Autonomic and subjective responsivity to emotional images in people with dissociative seizures

People with dissociative seizures (DS) report a range of difficulties in emotional functioning and exhibit altered responding to emotional facial expressions in experimental tasks. We extended this research by investigating subjective and autonomic reactivity (ratings of emotional valence, arousal and skin conductance responses [SCRs]) to general emotional images in 39 people with DS relative to 42 healthy control participants, whilst controlling for anxiety, depression, cognitive functioning and, where relevant, medication use. It was predicted that greater subjective negativity and arousal and increased SCRs in response to the affective pictures would be observed in the DS group. The DS group as a whole did not differ from controls in their subjective responses of valence and arousal. However, SCR amplitudes were greater in ‘autonomic responders’ with DS relative to ‘autonomic responders’ in the control group. A positive correlation was also observed between SCRs for highly arousing negative pictures and self‐reported ictal autonomic arousal, in DS ‘autonomic responders’. In the DS subgroup of autonomic ‘non‐responders’, differences in subjective responses were observed for some conditions, compared to control ‘non‐responders’. The findings indicate unaffected subjective responses to emotional images in people with DS overall. However, within the group of people with DS, there may be subgroups characterized by differences in emotional responding. One subgroup (i.e., ‘autonomic responders’) exhibit heightened autonomic responses but intact subjective emotional experience, whilst another subgroup (i.e., ‘autonomic non‐responders’) seem to experience greater subjective negativity and arousal for some emotional stimuli, despite less frequent autonomic reactions. The current results suggest that therapeutic interventions targeting awareness and regulation of physiological arousal and subjective emotional experience could be of value in some people with this disorder.     

THE TEXTURE OF TRAUMATIC ATTACHMENT: PRESENCE AND GHOSTLY ABSENCE IN TRANSGENERATIONAL TRANSMISSION

Work on the transgenerational transmission of trauma refers to unspoken stories across generations, but the actual mode of transmission has remained somewhat mysterious. Utilizing examples from her own life, the author illustrates how attachment patterns are a primary mode of transmission of trauma. When trauma revisits a person transgenerationally through dysregulated and disrupted attachment patterns, it is within the child's empathic attunement and search for a parental bond that the mode of transmission can be found. This will become the texture of traumatic attachment: how it feels to this child to feel connected to the parent.     

The Role of Religious Coping and Resilience in Individuals With Dissociative Identity Disorder

Survivors with dissociative identity disorder (DID) often report a history of traumatic events in their lives. Past studies indicated a link between trauma, resilience, and spiritual coping in both positive and negative aspects of a survivor's life. This article includes a review of existing literature salient to these constructs in relation to i ndividuals with DID, as well as results from a study examining the relationships between these constructs and individuals with DID (N = 52). Implications are discussed based on the findings for counselors treating individuals with DID.     

Deliberate Self-Harm and State Dissociation: An Experimental Investigation

The purpose of this study was to test the relation between deliberate self-harm (DSH) and state dissociation. Participants (N = 85) were randomly assigned to self-administer either a very mild electric shock below their pain threshold (a no-self-harm control condition) or an electric shock they were told could “cause minor tissue damage that would heal quickly,” but which was in fact equal to a predetermined pain threshold (a DSH condition). After task completion, 42 participants rated the extent of their dissociation before the shock and 43 rated the extent of their dissociation after the shock. Results indicated that women in the DSH group experienced more dissociation compared to men, but only after the shock. Potential reasons for this gender effect are discussed.     

创伤性分离个体注意加工的警戒-回避模式研究

采用点探测研究范式,对高分离个体和低分离个体在两种呈现时间500ms和1500ms条件下,随机呈现创伤性图片和中性图片,进行点探测反应,考察创伤性分离个体的注意加工特点.结果表明,高分离个体在500ms呈现时间条件下对创伤性图片的反应时间显著快于低分离个体对创伤图片刺激的反应时间,而在1500ms呈现时间条件下则显著慢于低分离个体.表明创伤性高分离个体的注意加工符合警戒-回避的时程性模式:开始时对创伤性刺激是一种保护性的警戒反应;在随后刺激的呈现时间增加时,回避对创伤相关信息的进一步编码和精细加工,出现有意遗忘,体现在提取和回忆上的减弱,我们称之为回避加工.     

Opening the closed heart: affect-focused clinical work with the victims of early trauma

This paper begins with the understanding that early trauma leads to powerful dissociative defenses which injure the capacity to feel. It further explores ways to restore this capacity through body-centred attention to affect-in-the-moment in the psychoanalytic situation. Using the author’s personal experience while in analysis as well as a case of severe early trauma, he demonstrates the consciousness-killing effect of primitive defenses and shows how body-sensitive techniques hold the promise of restoring the patient’s sense of aliveness and hence, opening the unconscious to those affect-images that are the building blocks of the human imagination. A final section focuses on the neglect of feeling in Jungian psychology and suggests that the “creation of consciousness” which Jung described as his personal myth, is quintessentially a process of emotional transformation – of bringing unconscious suffering into consciousness – as feelings.     

Dissociative identity disorder and ambivalence

While many theorists have argued that dissociative identity disorder (DID) is a case of multiple selves or persons in a single body, I maintain that DID instead should be understood as involving a single self who suffers from significant disruptions to self-consciousness. Evidence of overlapping abilities and memories, as well as the very logic of dissociation, supports the claim that DID results from internal conflict endured by a single self. Along these lines, I will maintain that alter-formation should be understood as the result of extreme emotional ambivalence. While it is true that subjects with DID exhibit volitional conflict, as Frankfurt [1988. The Importance of What We Care About. New York: Cambridge University Press; 1999. Necessity, Volition, and Love. New York: Cambridge University Press] maintains, I argue that these incompatible volitions have a deeper source: conflicting desires and affective stances concerning basic emotional needs that are not easily abandoned. A single subject turns to different alter-personalities as a way to cope with pervasive inner conflict while at the same time hiding contradictory impulses from herself.     

The Application of Attachment Theory and Mentalization in Complex Tertiary Structural Dissociation: A Case Study

The concept of structural dissociation can provide useful information for increasingly complex applications of mentalizing in therapeutic settings; however, little integration of the two approaches has emerged. Grounded in the intricate case of a woman diagnosed with dissociative identity disorder, this case study integrates and applies the concepts of structural dissociation and mentalizing from an attachment perspective. Client history includes pervasive spiritual and sexual abuse, as well as extreme neglect throughout her development. The presenting problems, relevant history (including the profound impact of neglect), and the therapeutic models that guided treatment are described. Also presented are the specific therapeutic interventions that have facilitated and strengthened therapeutic alliances, levels of integration, and mentalizing capacity in this challenging but rewarding study of human resiliency.     

Structure with Engagement: Toward an Integration of Trauma and Relational Psychoanalytic Models in the Treatment of Dissociative Disorders

Trauma model approaches to the treatment of dissociative disorders may provide containment and direction and yet, these same approaches may be constricting and limit exploration. However, relational psychoanalytic approaches may allow for engagement and exploration while potentially failing to provide containment and structure. This article provides an overview of key elements of both models and considers the question of whether it is possible to creatively resolve theoretical and clinical tensions between trauma model and relational psychoanalytic responses to dissociation. A review of the history of the study of dissociation in the field of psychoanalysis and concerns about psychoanalytic practice in the context of dissociation is followed by comparing contrasting conceptualizations of the assumptions of normality, definitions of dissociation, theories of etiology, goals of treatment, and theorized mechanisms of action. The review ends with a discussion of potential possibilities for clinical integration.     

Lived Experiences of Men With Dissociative Identity Disorder

Dissociative disorders affect 29% of the clinical population, with women diagnosed 9 times more often than men. For this study, the authors used a phenomenological approach to uncover experiences of 5 men with dissociative identity disorder. Findings revealed 5 themes: history, alters, male gender expectations and identity, challenges, and strengths and support. Implications for practitioners are discussed.