Dissociation and its disorders: Competing models, future directions, and a way forward

Lynn, Steven Jay; Maxwell, R. M.; Merckelbach, Harald; Lilienfeld, Scott O.; Kloet, Dalena van Heugten–van der; Miskovic, Vladimir

doi:10.1016/j.cpr.2019.101755

Cited by 88 publications

(154 citation statements)

References 240 publications

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“…For example, no participant described dissociative amnesia; however, several described memory blanking and experiencing their memories as unfamiliar. In line with Lynn et al [1], who state that 'it can be challenging, if not impossible, to distinguish amnesia from encoding failure', a number of participants stated that they were aware that their lack of memory for events related to periods when they were feeling unreal or detached. The results therefore highlight interviewees' subjective experience of their memory as somehow altered or anomalous.…”

Section: Key Findingsmentioning

confidence: 56%

“…Our results imply additional factors may also be important: beliefs about one's ability to cope with stress or (extreme) emotion, perceived powerlessness, and ambivalence about dissociation. The results of this study may therefore be of use in the search for 'transtheoretical variables' to explain dissociation [1].…”

Section: Placing the Findings In Contextmentioning

confidence: 87%

“…Dissociation is a complex phenomenon in mental health, with a large body of historical and contemporary publications outlining many (often opposing) frameworks [1]. Despite this wealth of literature, dissociative symptoms remain repeatedly under-recognized or misidentified [2].…”

Section: Introductionmentioning

confidence: 99%

“…Despite this wealth of literature, dissociative symptoms remain repeatedly under-recognized or misidentified [2]. Recognition of symptoms may be a particular challenge in dissociation due to the ongoing conceptual debate, which has negatively impacted the clarity of the construct [1,3], and because many clinicians receive inadequate training in this area [4].…”

Section: Introductionmentioning

confidence: 99%

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Describing the indescribable: A qualitative study of dissociative experiences in psychosis

2020

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Background Despite its long history, dissociation remains under-recognised clinically, partly due to difficulties identifying dissociative symptoms. Qualitative research may support its recognition by providing a lived experience perspective. In non-affective psychosis, identification of dissociation may be particularly important given that such experiences have been implicated its development and maintenance. Therefore, this study aimed to understand in the context of psychosis: what it is like to experience dissociation; the impact dissociation might have; what factors begin, maintain or end dissociative experiences; and what beliefs people hold about dissociation. Methods Qualitative interviews were carried out with twelve NHS patients with non-affective psychosis diagnoses and experience of dissociation. Data were analysed using Thematic Analysis. Results Dissociation involves subjective strangeness, unreality, disconnection, and shifts in perception. It impacts on mental health (including psychotic experiences), daily functioning, emotional connection, and can lead to social withdrawal. Stress, fatigue, and excessive internal focus may be involved in development and maintenance. Participants found it very difficult to describe the experience of dissociation, and, as a result, often did not mention it to others. Even when shared, interviewees reported that their descriptions were misunderstood and therefore they did not receive information or support specific to dissociation. The consensus was that experiences of dissociation are negative, but that understanding them better helped to enable coping. Conclusions The core subjective experience of dissociation appears to be a felt sense of anomaly (FSA), and we therefore suggest clinicians proactively enquire about such experiences.

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Section: Key Findingsmentioning

confidence: 56%

Section: Placing the Findings In Contextmentioning

confidence: 87%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Describing the indescribable: A qualitative study of dissociative experiences in psychosis

2020

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“…Dissociation and its disorders have long been the focus of clinical and research interest (Janet, 1873/1973). The term dissociation is generally considered to refer to a broad spectrum of experiences on a continuum from mild detachment from immediate surroundings and the self to more severe detachment from physical and emotional experiences ( Lynn et al, 2019 ). Central to the definition of dissociation is that key aspects of psychobiological functioning such as perception, memory, and identity which are normally seamlessly linked into consciousness are disturbed.…”

Section: Introductionmentioning

confidence: 99%

Poor sleep efficiency and daytime napping are risk factors of depersonalization disorder in female university students

Arora

Alhelali

Grey

2020

Neurobiology of Sleep and Circadian Rhythms

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Objectives Depersonalization is characterized by feelings of detachment from reality and has been associated with anxiety and depression, both of which have a bi-directional relationship with sleep. To date, few studies have directly examined the potential relationship between sleep and depersonalization, which was the primary objective of our study. Design/methods A cross-sectional study of female, Emirati, university students (n = 100) was conducted. Participants completed the Pittsburgh Sleep Quality Index (PSQI), the Cambridge Depersonalization Scale (CDS) and the Hospital Anxiety and Depression Scale (HADS). Additionally, 36 of the 100 participants wore wrist actigraphy for two consecutive weekdays. Average sleep duration, and average sleep efficiency (SE; %) across the two nocturnal sleep episodes were calculated. Total number of sleep episodes were obtained from wrist actigraphy and sleep logs. Results A significant, positive relationship was observed between PSQI global score and CDS total score (r = 0.21, p = 0.04). Actigraphy-estimated average nocturnal sleep duration was not significantly associated with the CDS. Compared to nocturnal sleepers only, those who undertook daytime naps had almost three times the risk of meeting the criteria for depersonalization disorder (OR = 2.95, 95% CI: 1.04–8.41), after adjustment. For each 1% increase in SE a 23% decreased risk of depersonalization was observed (OR = 0.77, 95% CI: 0.61–0.96), after adjustment. Conclusions Sleep screening in young adults may help to ensure better detection and management of psychological health outcomes. Our findings need to be confirmed prospectively in larger samples and amongst different populations but reiterate the importance of sleep habits pertaining to mental health.

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The path to dissociative experiences: A direct comparison of different etiological models

Buchnik-Daniely

Vannikov-Lugassi

Shalev

et al. 2021

Clin Psychology and Psychoth

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Severe dissociation is trauma‐related, but a range of dissociative experiences are also prevalent in clinical populations that are not necessarily trauma‐based (e.g., depression, anxiety disorders, and obsessive–compulsive disorders). These remain poorly understood as the dominant etiological model for dissociation relies on trauma. Importantly, dissociation in such samples predicts poor prognosis and high drop‐out rates. We set out to better understand the aetiology of dissociative experiences in a mixed clinical (anxiety and depression) and community sample by exploring between‐ and within‐subjects effects of two domains: psychological distress or negative affectivity (operationalized as anxiety and depression symptoms), and poor sleep quality, including disturbed dreaming. The idea that negative affectivity triggers dissociation (Distress Model) is inspired by the trauma model. The idea that poor sleep and unusual dreaming underlie dissociation (Sleep Model) has been suggested as a competing theory. We examined both models by exploring which domains oscillate alongside dissociative experiences. N = 98 adults, half of them diagnosed with depression and anxiety and half community controls, underwent a structured clinical interview and completed questionnaires monthly for 6 months. Support was found for both models in that each domain had a unique explanatory contribution. Distress evinced consistent effects that could not be explained by sleep or dreaming, both between individuals and across time. Oscillations in dissociation across months, when taking psychological distress into account, were better explained by unusual dreaming than traditional sleep quality measures. These findings cannot be generalized to highly‐traumatized samples. A complex, integrated etiological model for dissociative experiences is warranted.

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Dissociation and its disorders: Competing models, future directions, and a way forward

Cited by 88 publications

References 240 publications

Describing the indescribable: A qualitative study of dissociative experiences in psychosis

Describing the indescribable: A qualitative study of dissociative experiences in psychosis

Poor sleep efficiency and daytime napping are risk factors of depersonalization disorder in female university students

The path to dissociative experiences: A direct comparison of different etiological models

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