Is the Dissociative Adult Suggestible? A Test of the Trauma and Fantasy Models of Dissociation

Psychologists have long assumed a connection between traumatic experience and psychological dissociation. This hypothesis is referred to as the trauma model of dissociation. In the past decade, a series of papers have been published that question this traditional causal link, proposing an alternative fantasy model of dissociation. In the present research, the relationship among dissociation, suggestibility, and fantasy proneness was examined. Suggestibility was measured through the Gudjonsson Scale of Interrogative Suggestibility (GSS) as well as an autobiographically based version of this measure based on the events of September 11, 2001. Consistent with prior research and with the trauma model, dissociation correlated positively with trauma severity (r = .32, p < .01) and fantasy proneness (r = .60, p < .01). Inconsistent with the fantasy model, dissociation did not correlate with the neutral form of the GSS and correlated negatively (r = –.24, p < .05) with the trauma-focused form of this suggestibility measure. Although some participants did become quite emotional during the procedure, the risk/benefit ratio was perceived by almost all participants to be positive, with more reactive individuals evaluating the procedure more positively. The results consistently support the trauma model of dissociation and fail to support the fantasy model of dissociation.     

Children who speak of past‐life experiences: Is there a psychological explanation?

Children who claim to remember fragments of a past life are found in some countries. Various explanations have been put forward as to why the alleged memories develop, ranging from reincarnation to ‘therapeutic resource’. This study puts to the test the role of some psychological characteristics and the circumstances in which the children live, such as fantasy, suggestibility, social isolation, dissociation, and attention‐seeking. Thirty children in Lebanon who had persistently spoken of past‐life memories, and 30 comparison children, were administered relevant tests and questionnaires. The target group obtained higher scores for daydreaming, attention‐seeking, and dissociation, but not for social isolation and suggestibility. The level of dissociation was much lower than in cases of multiple personality and not clinically relevant. There was some evidence of post‐traumatic stress disorder‐like symptoms. Eighty per cent of the children spoke of past‐life memories of circumstances leading to a violent death (mostly accidents, also war‐related deaths and murder). It is discussed if this imagery—when experienced repeatedly—may serve as a stressor.     

Trauma and anxious attachment influence the relationship between suggestibility and dissociation: a moderated-moderation analysis

Introduction: Hypnotic suggestibility is elevated in the dissociative disorders but the relationship between dissociative tendencies and suggestibility in the general population seems to be constrained by additional factors. The diathesis-stress (DS) model stipulates that suggestibility interacts with trauma exposure to augment the propensity for dissociative states whereas the dual pathway to suggestibility (DPS) model proposes two developmental routes involving either dissociation preceded by trauma, or a healthy cognitive profile characterised by superior imagination.

Methods: This study sought to discriminate between these partially competing accounts and further considered the moderating role of anxious attachment. 209 participants completed psychometric measures of dissociative tendencies, trauma, and attachment, and a behavioural measure of suggestibility.

Results: In support of the DS model, trauma moderated the relationship between suggestibility and dissociation and, as predicted by the DPS model, dissociation moderated the relationship between trauma and suggestibility. Anxious attachment additionally moderated both effects. Model comparisons indicated that the DS model consistently provided a superior fit to the data. Further analyses showed that secure attachment independently predicted suggestibility, thereby supporting the non-dissociative pathway in the DPS model.

Conclusions: These results suggest that high suggestibility confers vulnerability to dissociative states in individuals exposed to trauma and displaying an anxious attachment style.     

Peritraumatic Somatoform and Psychological Dissociation in Relation to Recall of Childhood Sexual Abuse

Abstract

Objective: Overwhelming experience can evoke psychological dissociation during or immediately after the event, including dissociative amnesia. Whereas some data suggest that such peritraumatic dissociation can also find expression in somatoform symptoms, only a limited range of such symptoms has been systematically studied. The present study hypothesized that peritraumatic psychological and somatoform dissociation are associated with each other, with delayed recall of childhood sexual abuse (CSA), and with CSA severity. Because current somatoform dissociation is most strongly associated with recalled childhood physical abuse (CPA), we also hypothesized that peritraumatic somatoform dissociation is associated with reported CPA over and above CSA.

Method: Thirty-four Dutch women who reported CSA were interviewed using a modified version of the Traumatic Memory Inventory (TMI) which assesses the characteristics of traumatic memories. The participants also completed the Traumatic Experiences Checklist, the Peritraumatic Dissociation Experiences Questionnaire, and the Peritraumatic Somatoform Dissociation Questionnaire.

Results: Peritraumatic psychological and somatoform dissociation were associated with each other, with delayed recall of trauma, and with severity of reported CS A. Reported CPA predicted peritraumatic somatoform dissociation over and above the severity of CS A in terms of the acts involved. Approximately 44% of the women reported independent corroboration of the abuse. Similar proportions of delayed, partial, and continuous CSA memories were corroborated.

Conclusions: This retrospective study suggested that delayed recall of CSA is associated with peritraumatic dissociation and CSA severity. It also suggested that trauma-especially that which involves serious threat to the integrity of the body-may evoke somatoform dissociation. Based on patient report, delayed recall of some CSA memories was as accurate as continuous recall of CSA.     

Differential Effects of REM Sleep on Emotional Processing: Initial Evidence for Increased Short-term Emotional Responses and Reduced Long-term Intrusive Memories

ABSTRACT

Background: Rapid eye movement (REM) sleep has been postulated to facilitate emotional processing of negative stimuli. However, empirical evidence is mixed and the conditions under which higher amounts of REM sleep lead to decreased or increased emotional responses are unclear. We proposed that the time course between REM sleep and measurement of emotional responses is a crucial factor and hypothesized that more REM sleep will enhance emotional responses shortly after sleep, but will lead to decreased emotional responses in the long-term.

Participants and Methods: Seventy-six healthy young women watched negative and neutral pictures before a polysomnographically-recorded nap including three different groups (1: no REM sleep, 2: REM sleep awakening, 3: REM sleep). Short-term emotional responses were measured using aversiveness ratings of negative pictures; aversiveness ratings of intrusive picture memories on the three subsequent evenings were used to measure long-term emotional responses.

Results: For short-term emotional responses, no significant interaction indicating group differences was found. However, we found correlations between longer REM sleep duration and higher aversiveness ratings of negative pictures. In contrast, lower aversiveness of intrusive picture memories after two days was found in participants with a full REM sleep period compared to individuals without REM sleep. Correlational analyses also supported this pattern of results.

Conclusions: Results suggest that REM sleep may increase reactivity to emotional stimuli in the short-term and this effect of REM sleep appears to facilitate emotional processing during subsequent nights leading to reduced intrusive picture memories in the long-term.     

Emotional Distress of the COVID-19 Cluster Infection on Health Care Workers Working at a National Hospital in Korea

BackgroundFrontline healthcare workers responding to coronavirus disease 2019 (COVID-19) inevitably face tremendous psychological burden. Thus, the present study aimed to identify the psychological impact and the factors contributing to the likely increase in emotional distress of healthcare workers.MethodsThe participants include a total of 99 healthcare workers at Bugok National Hospital. Psychometric scales were used to assess emotional distress (12-item General Health Questionnaire; GHQ-12), depression symptoms (Patient Health Questionnaire-9; PHQ-9), and post-traumatic stress disorder-related symptoms (Impact of Events Scale-Revised; IES-R). A supplementary questionnaire was administered to investigate the experience of healthcare workers exposed to COVID-19-infected patients. Based on the results of GHQ-12 survey, participants were categorized into two groups: distress and non-distress. All the assessed scores were compared between the two groups. A logistic regression model was constructed to identify factors associated with emotional distress.ResultsEmotional distress was reported by 45.3% (n = 45) of all participants. The emotionally distressed group was more likely to be female, manage close contacts, have higher scores on PHQ-9 and IES-R, feel increased professional risk, and report that proper infection control training was not provided. Female gender, managing close contacts, higher scores on PHQ-9, and a feeling that proper infection control training was not provided were associated with emotional distress in logistic regression.ConclusionFrontline healthcare workers face tremendous psychological burden during the COVID-19 pandemic. Therefore, appropriate psychological interventions should be provided to the HCWs engaged in the management of COVID-19-infected patients.     

Memory Fragmentation in Dissociative Identity Disorder

ABSTRACT

This study examined the quality of self-reported memories of traumatic experiences in participants with dissociative identity disorder (DID) and compared them with their memories of non-traumatic, but emotionally significant life experiences. Systematic interview data were gathered from 30 DID patients in The Netherlands. All participants reported a history of severe childhood abuse; 93.3% reported some period of amnesia for the index traumatic event, and 33.3% reported periods of amnesia for significant non-traumatic childhood experiences. All participants who had been amnestic for their trauma reported that their memories were initially retrieved in the form of somatosensory flashbacks. This suggests that, like PTSD patients, DID patients at least initially recall their trauma not as a narrative, but as somatosensory re-experiencing. Surprisingly, however, DID participants also recalled emotionally charged non-traumatic life events with significant somatosensory components, a phenomenon that has not been previously reported. This finding raises important issues regarding basic memory processing abnormalities in DID patients.     

Personality profiles, dissociation, and absorption in women reporting repressed, recovered, or continuous memories of childhood sexual abuse

Women reporting either repressed, recovered, or continuous memories of childhood sexual abuse or no abuse history completed questionnaires tapping personality traits, absorption (fantasy proneness), dissociation, depression, and posttraumatic stress. Planned contrasts indicated that recovered memory participants scored higher on absorption and dissociation than did those reporting either continuous memories or no abuse history; repressed memory participants scored nonsignificantly higher than did recovered memory participants. On measures of distress, continuous memory participants were indistinguishable from nonabused participants, repressed memory participants scored highest, and recovered memory participants scored midway between continuous and repressed memory participants.     

Divergent Perspectives in Prostitutes' Autobiographical Memories: Trauma and Dissociation

ABSTRACT

An intriguing aspect of cognition is the perspective one takes when perceiving and/or remembering an event (i.e., field vs. observer perspectives/memories). Although explored from a cognitive viewpoint in terms of remembering, no research has examined this phenomenon from a forensic viewpoint in terms of the original experienced perspective. The objective of the present study was to test the utility of the field vs. observer distinction. Thirty-six prostitutes were interviewed and asked to recall three different autobiographical memories. Peri-traumatic dissociative symptoms, trait dissociation levels, current PTSD symptomatology, the perspective taken, and the quantity of detail were coded for each memory and compared. Extreme memorial variability was found both within and across the types of memories/perspectives reported. Among other findings, the results suggest significantly higher levels of state dissociation in memories originally perceived from an observer perspective than from a field perspective. Implications for expert testimony pertaining are briefly discussed.     

The Professional Fragmentation of Experience in the Study of Dissociation,Somatization, and Culture

Abstract

The prevailing “dis-association” between the scientific studies of dissociation and somatization is discussed, particularly in reference to the general “decontextualization” of dissociative and somatic experiences from their sociocultural context. The claim is made that this constitutes a fragmentation, in the professional sense, of naturally related phenomena. Conceptual and sociohistorical factors are identified that, at least partly, seem to explain these artificial divisions. Empirical evidence of the co-morbidity of dissociative and somatic symptoms is reviewed and some proposed theoretical notions are discussed. The role of cultural factors in shaping dissociative and somatic experiences is examined at the levels of (a) awareness of an event, (b) significance ofthat event, (c) emotional response, (d) locus of experience (i.e., somatic or psychological), (e) symptomatic response, and (f) social interaction. The practical relevance of recognizing the relationship among dissociation, somatization, and culture is illustrated through the presentation and discussion of anecdotal clinical material. It is also suggested that a more comprehensive study of the inter face of dissociation, somatization and culture requires the integration of quantitative and qualitative research methodologies.     

The false memory syndrome: experimental studies and comparison to confabulations

False memories, or recollections that are factually incorrect but strongly believed, remain a source of confusion for both psychiatrists and neurologists. We propose model for false memories based on recent experimental investigations, particularly when analyzed in comparison to confabulations, which are the equivalent of false memories from neurological disease. Studies using the Deese/Roedinger-McDermott experimental paradigm indicate that false memories are associated with the need for complete and integrated memories, self-relevancy, imagination and wish fulfillment, familiarity, emotional facilitation, suggestibility, and sexual content. In comparison, confabulations are associated with the same factors except for emotional facilitation, suggestibility, and sexual content. Both false memories and confabulations have an abnormal sense of certainty for their recollections, and neuroanatomical findings implicate decreased activity in the ventromedial frontal lobe in this certainty. In summary, recent studies of false memories in comparison to confabulations support a model of false memories as internally-generated but suggestible and emotionally-facilitated fantasies or impulses, rather than repressed memories of real events. Furthermore, like confabulations, in order for false memories to occur there must be an attenuation of the normal, nonconscious, right frontal "doubt tag" regarding their certainty.     

Children's basic memory processes, stress, and maltreatment

Building upon methods and research utilized with normative populations, we examine extant assumptions regarding the effects of child maltreatment on memory. The effects of stress on basic memory processes is examined, and potential neurobiological changes relevant to memory development are examined. The impact of maltreatment-related sequelae (including dissociation and depression) on basic memory processes as well as false memories and suggestibility are also outlined. Although there is a clear need for additional research, the investigations that do exist reveal that maltreated children's basic memory processes are not reliably different from that of other, nonmaltreated children.     

Depressive Symptoms and Sleep Disturbance in Adults with Histories of Childhood Abuse

Abstract

Depressive symptoms including sleep disturbance are clinically apparent in many patients with histories of childhood abuse. This study investigated the nature and severity of depressive symptoms, sleep disturbance, and trauma-related symptoms in a group of female participants with abuse histories, as compared to a non-abused group of female participants with major depression. Sixty (60) participants with a history of childhood abuse and 13 participants with major depression completed several self-report instruments which examine past life experiences, depressive symptoms, post-traumatic symptoms, dissociative symptoms, and sleep problems. To control for differences in background characteristics, a subset of participants with abuse histories were matched to and compared with the 13 depressed participants. Both the abused and depressed groups showed high levels of depressive symptoms, but there were no significant differences between the groups. The abused group had significantly more intrusive post-traumatic symptoms, more dissociative symptoms, and were more likely to be afraid of falling asleep and more anxious upon mid-sleep awakening. Severity of depressive symptoms in the abused group was correlated with severity of intrusive post-traumatic symptomatology. The investigators conclude that symptoms of major depression in some patients with abuse histories may have a post-traumatic etiology, especially since intrusive reexperi-encing of past trauma may produce severe dysphoria and hopelessness. The nature of sleep disturbance in patients with abuse histories may be a clinical tool to identify patients whose depressive symptoms may be post-traumatic in origin.     

“Implicit Memory” Cannot Explain Dissociated Traumatic Memory: A Theoretical Critique

ABSTRACT

Similarities between implicit memories and unprocessed traumatic memories have led traumatologists to equate them. Both have “physicality”: They are grounded in the body rather than narrative, being retrieved in sensations, motor responses, affects, ego states, and images. Sheltered from the cognitive processes that use language to alter memories, they remain stable over time, unconscious, and dependent on specific retrieval cues that replicate part of the original event. Nevertheless, if dissociation produces unprocessed traumatic memories whereas association produces implicit memories, how can they be identical? I argue that they differ in the causal mechanisms and unconscious strategies that the self uses to process their physicality. I hypothesize that unprocessed traumatic memories change over time if the self integrates their physicality into its central goals and meanings, its core, making them less similar to implicit memories and more similar to normal event memories. I propose a new concept, “self-embodied memories”–related to concepts developed by Elin (1997) and Glenberg (1997)–that, like the concept of implicit memory, captures memory's physicality but also relates it to the self s processing strategies. A clinical vignette illustrates changes in a child's unprocessed traumatic memory as it became integrated with her sense of self.     

Trauma-Relevant Characteristics in a University Human Subjects Pool Population: Gender,Major, Betrayal,and Latency of Participation

ABSTRACT

This study of over 700 participants is the first to examine whether students in a university human subjects pool (HSP) population differ systematically by gender, major, and participation time (early versus late in the term) on characteristics relevant to trauma research. Males and females reported equal amounts of overall child and adult trauma, and equal amounts of low-betrayal trauma. Females reported more child and adult high-betrayal trauma (i.e., trauma perpetrated by someone close) than did males. Females also reported more current post-traumatic stress disorder (PTSD) symptoms than did males. Psychology majors reported more high-betrayal trauma and low-betrayal traumatic events in childhood, as well as more adult low-betrayal trauma, than did non-majors. Dissociation was correlated with all types of trauma. Current age was positively correlated with reporting trauma, regardless of age at which the trauma was experienced. Additionally, students who participated later in the term were, on average, more than a year older than those who participated earlier in the same term. There was no significant difference between early and late participants on any measure of trauma, PTSD symptoms, or dissociation. Implications for the use of HSPS in studying trauma and future research directions are addressed.     

Individual differences in the accuracy of autobiographical memory

In recent literature on ‘false memories’, autobiographical memory distortions are often linked to manipulations such as hypnosis or imagination. However, Barclay and Wellman (1986) demonstrated that such distortions might also occur more or less spontaneously. The current study sought to replicate this phenomenon. In addition, it examined whether certain personality traits, (i.e. fantasy proneness, dissociation, absorption, suggestibility and depression) might contribute to such spontaneous pseudo‐memories. Volunteers (N = 38) kept a diary of self‐selected, outstanding events for a 2‐week period. Six months later, they were unexpectedly given a recognition test consisting of original memories and several types of foils. Participants performed relatively well on the recognition task, although they had some difficulties differentiating original items from foil items. Curiously enough, fantasy proneness was related to superior recognition performance. Copyright © 2004 John Wiley & Sons, Ltd.     

Some Characteristics of Positive and Negative (“Most Traumatic”) Event Memories in a College Sample

Abstract

Discrepant findings from cognitive science and clinical research underpin the debate regarding the nature of traumatic memory and raise issues regarding the generalizability of conclusions from non-clinical samples to traumatized clinical populations. In the present study, we replicated and extended a cognitive study by Christianson and Loftus (1990) by comparing characteristics of positive and negative (“most traumatic”) childhood event memories in a college sample and rating the negative memory reports against a clinically-defined standard for traumatic events. Results indicated that negative and positive memories were similar in their ease of recall, vividness, amount of central and peripheral details, degree of past emotion, and amount of discussion of the event. However, negative memories were associated with significantly less present emotion than positive memories and more instances of a highly memorable detail. Expert judges determined that only 8% (4/48) of the negative memory events met the traumatic event exposure criterion for PTSD, and none of these events was associated with self-reported symptomatology sufficient to indicate a likely current PTSD diagnosis. Four other negative events were associated with elevated symptomatology. These results suggest that many of the claims regarding the characteristics of what have been called “traumatic” memories may instead describe emotional memories in general. Further, life events that nonclinical samples identify as “most traumatic” may not correspond to clinically-defined traumatic events. Consequently, caution should be exercised in generalizing negative memory findings from nonclinical samples -even if described as “traumatic” -to describe or explain memories in clinical populations with severe event exposure or posttraumatic symptomatology.     

Clinical characteristics of adults reporting repressed, recovered, or continuous memories of childhood sexual abuse

The authors assessed women and men who either reported continuous memories of their childhood sexual abuse (CSA, n = 92), reported recovering memories of CSA (n = 38), reported believing they harbored repressed memories of CSA (n = 42), or reported never having been sexually abused (n = 36). Men and women were indistinguishable on all clinical and psychometric measures. The 3 groups that reported abuse scored similarly on measures of anxiety, depression, dissociation, and absorption. These groups also scored higher than the control group. Inconsistent with betrayal trauma theory, recovered memory participants were not more likely to report abuse by a parent or stepparent than were continuous memory participants. Rates of depression and posttraumatic stress disorder did not differ between the continuous and recovered memory groups.     

Heart rate,startle response,and intrusive trauma memories

The current study adopted the trauma film paradigm to examine potential moderators affecting heart rate (HR) as an indicator of peritraumatic psychological states and as a predictor of intrusive memories. We replicated previous findings that perifilm HR decreases predicted the development of intrusive images and further showed this effect to be specific to images rather than thoughts, and to detail rather than gist recognition memory. Moreover, a group of individuals showing both an atypical sudden reduction in HR after a startle stimulus and higher trait dissociation was identified. Only among these individuals was lower perifilm HR found to indicate higher state dissociation, fear, and anxiety, along with reduced vividness of intrusions. The current findings emphasize how peritraumatic physiological responses relate to emotional reactions and intrusive memory. The moderating role of individual difference in stress defense style was highlighted.     

Suggestibility and signal detection performance in hallucination-prone students

Introduction: Auditory hallucinations are associated with signal detection biases. We examine the extent to which suggestions influence performance on a signal detection task (SDT) in highly hallucination-prone and low hallucination-prone students. We also explore the relationship between trait suggestibility, dissociation and hallucination proneness.

Method: In two experiments, students completed on-line measures of hallucination proneness (the revised Launay–Slade Hallucination Scale; LSHS-R), trait suggestibility (Inventory of Suggestibility) and dissociation (Dissociative Experiences Scale-II). Students in the upper and lower tertiles of the LSHS-R performed an auditory SDT. Prior to the task, suggestions were made pertaining to the number of expected targets (Experiment 1, N?=?60: high vs. low suggestions; Experiment 2, N?=?62, no suggestion vs. high suggestion vs. no voice suggestion).

Results: Correlational and regression analyses indicated that trait suggestibility and dissociation predicted hallucination proneness. Highly hallucination-prone students showed a higher SDT bias in both studies. In Experiment 1, both bias scores were significantly affected by suggestions to the same degree. In Experiment 2, highly hallucination-prone students were more reactive to the high suggestion condition than the controls.

Conclusion: Suggestions may affect source-monitoring judgments, and this effect may be greater in those who have a predisposition towards hallucinatory experiences.