Dissociation and Dissociative Disorders Reconsidered: Beyond Sociocognitive and Trauma Models Toward a Transtheoretical Framework

Abstract

For more than 30 years, the posttraumatic model (PTM) and the sociocognitive model (SCM) of dissociation have vied for attention and empirical support. We contend that neither perspective provides a satisfactory account and that dissociation and dissociative disorders (e.g., depersonalization/derealization disorder, dissociative identity disorder) can be understood as failures of normally adaptive systems and functions. We argue for a more encompassing transdiagnostic and transtheoretical perspective that considers potentially interactive variables including sleep disturbances; impaired self-regulation and inhibition of negative cognitions and affects; hyperassociation and set shifts; and deficits in reality testing, source attributions, and metacognition. We present an overview of the field of dissociation, delineate uncontested and converging claims across perspectives, summarize key multivariable studies in support of our framework, and identify empirical pathways for future research to advance our understanding of dissociation, including studies of highly adverse events and dissociation. Expected final online publication date for the Annual Review of Clinical Psychology, Volume 18 is May 2022. Please see http://www.annualreviews.org/page/journal/pubdates for revised estimates.

The Memory Wars Then and Now: The Contributions of Scott O. Lilienfeld

“…In fact, Lynn et al (2022) have speculated that DID, the belief in personal multiplicity, and alter personalities arise from a fundamental attribution (or misattribution) error whereby failures to control, modulate, or suppress puzzling or disturbing thoughts, emotions, and memories are attributed to a fragmented self or alter personalities. Therapists who treat the patient as if they truly embody separate personalities would be expected to exacerbate this error and potentially be more prone to attempt to recover memories presumptively segregated from other memories because of amnesic barriers.…”

“…Therapists who treat the patient as if they truly embody separate personalities would be expected to exacerbate this error and potentially be more prone to attempt to recover memories presumptively segregated from other memories because of amnesic barriers. Thus, when reified and reinforced in psychotherapy, or in daily living, this attribution can become expressible as a new identity consistent with DID (Lynn et al, 2022).…”

“…Assessing the circumstances in which therapists implement memory recovery in psychotherapy and the link of the use of such methods with different diagnoses Systematizing how case studies of dissociative amnesia should be reported, including the need for thorough evaluation of alternative hypotheses, as noted among the recommendations offered by Mangiulli et al (2022) Conducting qualitative/phenomenological (Millière, 2017) and quantitative studies on how individuals come to perceive themselves as fractured and develop so-called alters over the course of therapy and apart from therapy Conducting research that evaluates and discriminates disturbances in the embodied self, the social self, the self as agent, and the self that is associated with a coherent sense of memory and identity (see Lynn et al, 2022) Conducting systematic studies of "retractors" versus individuals who maintain a sense of a divided self that is based on recovered memories Studying variables that mediate whether individuals interpret experiences as abuse or in more benign terms and the evolution of memories and beliefs about past occurrences over time Conducting longitudinal studies with diverse populations that include measures of attachment (Schimmenti, 2016), memory, and the variables that we delineated as potential mediators of dissociation Conducting laboratory studies in which measures derived from different etiological models are compared in the context of the same study Employing advanced statistical techniques to map networks of interacting variables onto a more comprehensive and refined theoretical scheme (McNally, 2016(McNally, , 2021Schimmenti, 2018) Conducting studies that engender dissociation and/ or emotional reactivity in the laboratory and examine the resultant effects on memory and other cognitive functions Comparing the effectiveness of therapies that, to varying extents, rely on memory exploration and/or recovery Systematically studying potentially iatrogenic or harmful therapeutic methods, including memory recovery procedures, using well-validated measures of negative effects Examining the influence of informed consent procedures (e.g., warnings regarding the possibility of false memories) on positive and negative sequelae of psychotherapy (Lynn, 2001) Conducting research on the relation of familiarity with diverse media regarding DID and beliefs about memory, memory recovery, and dissociation Conducting studies on the link between dissociation and cases of corroborated versus uncorroborated memories of traumatic events…”

Obsessive-compulsive symptoms and dissociative experiences: Suggested underlying mechanisms and implications for science and practice

“…In recent years evidence has accumulated to suggest a strong link between obsessive-compulsive disorder (OCD) or obsessive-compulsive symptoms (OCS) on one hand (henceforth OCD/S), and a tendency for dissociative experiences on the other hand, including episodes of depersonalization and derealization (sensations of detachment or estrangement from one’s self or the environment, respectively; American Psychiatric Association [APA], 2013 ), and “absorption and imaginative involvement” (AII; Carlson and Putnam, 1993 ), (i.e., a tendency for experiencing immersive attention toward an internal or external stimulus, accompanied by obliviousness to surroundings). Dissociative experiences seem to be a transdiagnostic construct relevant to several psychiatric disorders ( Soffer-Dudek, 2014 ; Ellickson-Larew et al, 2020 ; Buchnik-Daniely et al, 2021 ; Lynn et al, 2022 ). It has been suggested that dissociative experiences may interact in specific ways with various disorders, and those specific interactive paths should be studied to advance the understanding of both dissociation and the respective disorders ( Soffer-Dudek, 2014 ).…”

Case Report: Anomalous Experience in a Dissociative Identity and Borderline Personality Disorder

“…Among the latter, the socio-cognitive model highlights the importance of social-cultural self-oneness as the cause of deterioration of chronological, biographical, and perceptive unity ( 1 , 2 , 4 ), while the trauma model, which has received more support and was studied more, underlies the role of traumatic life experiences ( 6 , 7 ). Very recently, aligned with the transdiagnostic model, it was proposed that dissociation can be understood as failures of normally adaptive systems and functions ( 8 ).…”