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

Laria, Amaro J.; Lewis‐Fernández, Roberto

doi:10.1300/j229v02n03_03

Cited by 9 publications

(8 citation statements)

References 60 publications

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“…Within this perspective, DID is not a manifestation of suggestion and role-playing as some authors believe (Lilienfeld et al, 1999;Spanos, & Burgess, 1994), but an extreme on a dimension of trauma-related mental disorders (Draijer & Boon, 1999;Brown, Frischholz, & Scheflin, 1999). However, the theory also holds that secondary elaboration and shaping of previously evoked dissociative mental systems may occur, e.g., by a range of psychological, social, and cultural influences (Laria & Lewis-Fernández, 2001). We have presented a body of empirical and experimental data that support, or that are at least consistent with, the proposed theory.…”

Section: Resultsmentioning

confidence: 99%

Trauma-related Structural Dissociation of the Personality

2010

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Many traumatized individuals alternate between re-experiencing their trauma and being detached from, or even relatively unaware of the trauma and its effects. At first sight one may be inclined to conceptualize detachment from trauma and reexperiencing of trauma as mental states. However, on closer scrutiny it becomes apparent that in both cases a range or cluster of states rather than a singular state is involved. For example, being detached from trauma does not itself exclude being joyful, ashamed, sexually aroused, or curious at times, and re-experiencing trauma can encompass states such as fleeing, freezing, and being in pain or being analgesic. In this paper we relate detachment from trauma and reexperiencing trauma to emotional operating systems (Panksepp, 1998) and functional systems (Fanselow & Lester, 1988), briefly addressed as action systems. Action systems control a range of functions, but some are more complex than others. Reexperiencing trauma will be associated with the inborn and evolutionary derived defensive system that is evoked by severe threat, in particular threat to the integrity of the body. As a complex system, it encompasses various subsystems, such as flight, freeze, and fight. Detachment from trauma, in our view, is associated with several action systems (Panksepp, 1998), i.e., the ones that control functions in daily life (e.g., exploration of the environment, energy control), and the ones that are dedicated to survival of the species (e.g., reproduction, attachment to and care for offspring). In this context we will maintain that severe threat may provoke a structural dissociation of the premorbid personality ( . In its primary form this dissociation is between the defensive system on one hand, and the systems that involve managing daily life and survival of the species on the other hand. To summarize the essence of the theory of structural dissociation of the personality, we argue (1) that traumatic experiences, especially when they occur early in life and involve severe threat to the integrity of the body, may activate psychobiological action systems that have been developed by evolution, and (2) that due to extreme stress levels and classical as well as evaluative conditioning to traumatic memories these systems may remain unintegrated to varying degrees.

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Section: Resultsmentioning

confidence: 99%

Trauma-related Structural Dissociation of the Personality

2010

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“…For example, a number of commentators have noted that symptoms such as unexplained amnesia, blindness, fainting, paralysis, convulsions, loss of consciousness, weakness, and dizziness characterize some ataques de nervios (e.g., Guarnaccia, Rubio-Stipec & Canino, 1989;Interian et al, 2005;Laria & Lewis-Fernández, 2001). When present, these pseudoneurological symptoms tend to occur alongside a range of physical, anxiety, and depressive symptoms, with the particular constellation of somatic and psychological complaints varying from one case to another (Guarnaccia et al, 1989;.…”

Section: What Is the Cross-cultural Validity Of Existing Conversion Dmentioning

confidence: 99%

Culture and Conversion Disorder: Implications for DSM-5

Brown¹,

Lewis‐Fernández²

2011

Psychiatry: Interpersonal and Biological Processes

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The diagnostic criteria and related features of conversion disorder are under revision for DSM-5, including the requirement that psychological factors accompany the symptoms or deficits in question (Criterion B) and whether conversion disorder should be re-labeled as a dissociative, rather than a somatoform, condition. We examined the cross-cultural evidence on the prevalence, characteristics, and associated features of pseudoneurological symptoms more generally, and conversion disorder in particular, in order to inform the ongoing re-evaluation of the conversion disorder category. We also examined the relationship between these constructs and dissociative symptoms and disorders across cultural groups. Searches were conducted of the mental health literature, particularly since 1994, regarding culture, race, or ethnicity factors related to conversion disorder. Many proposed DSM-5 revisions were supported, such as the elimination of Criterion B. We also found cross-cultural variability in predominant symptoms, disorder prevalence, and relationship with cultural syndromes. Additional information that may contribute to DSM-5 includes the elevated rates across cultures of traumatic exposure and psychiatric comorbidity in conversion disorder. Cross-culturally, conversion disorder is associated strongly with both dissociative and somatoform presentations, revealing no clear basis on which to locate the disorder in DSM-5. Careful consideration should be given to the possible alternatives.

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“…The same situation may evoke widely different emotional expressions from different cultural groups (Mills, 2001;Nader, in press). Culturally recognized and sanctioned ways of expressing depression or anxiety may range from silent suffering to intense emotionality (Boehnlein, 2001;Laria & Lewis-Fernández, 2001;Lee et al, 2001;Shiang, 2000;de Silva, 1999;Velez-Ibanez & Parra, 1999). For some cultures (e.g., Asian, Middle Eastern), voicing mental health problems may shame or stigmatize (Kinzie, 1993;Shiang, 2000).…”

Section: Reporting Practicesmentioning

confidence: 99%

“…An important current debate on the boundaries of the definition of dissociation involves the status of somatic presentations of dissociative experience (Kihlstrom, 1992;Laria & Lewis-Fernández, 2001;Nemiah, 1991;Nijenhuis, Spinhoven, van Dyck, van der Hart, & Vanderlinden, 1998a). Nineteenth-century work on dissociation by Charcot, Janet, Freud, and others encompassed both psychological and somatic presentations under the general category of hysteria (Ellenberger, 1970).…”

Section: Somatoform Dissociationmentioning

confidence: 99%

“…This variation may stem from cultural differences at any of several stages involved in the experiencing of traumatic events, including awareness and interpretation of the event, the nature of the distress response, the primary locus of experience (i.e., somatic or psychological), the symptomatological behavioral response, and the ensuing social interaction (Laria and Lewis-Fernández, 2001). For example, a large community study in New Zealand (N = 1,028) found that only childhood physical abuse and not childhood sexual abuse was directly related to subsequent dissociative symptoms.…”

Section: Relationship Between Trauma and Dissociationmentioning

confidence: 99%

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