The mediating role of trait mindfulness and dissociative experiences in the relationship between childhood emotional abuse and problematic internet use in Italian adolescents.

There is clear evidence linking trauma, mindfulness, dissociation and problematic internet use (PIU). Nonetheless, little is known about the role trait mindfulness and dissociative experiences may have in the relationship between childhood emotional abuse (CEA) and PIU, as well as the role that gender may have in such relationships. In the current research, self-report questionnaires on CEA, trait mindfulness, dissociative experiences and PIU were administered to 1074 Italian adolescents (50% females) aged 14-17 years old, to test whether trait mindfulness and dissociative experiences mediated the relationship between CEA and PIU, and whether the proposed mediation was invariant across genders. Furthermore, the main analyses were controlled for background variables. The findings highlighted significant associations between all direct and indirect paths and invariance of the mediation model across boys and girls. The results of this study highlight that emotionally abused boys and girls with high levels of dissociation and inadequate mindful skills may be more exposed to dysfunctional online activities. Hence, developing dissociation-focused and mindfulness-based interventions for emotionally abused adolescents may be clinically effective when building tailored approaches for the prevention and management of PIU. Further implications are discussed.

Acute dissociation as part of the defense cascade: Associations with behavioral, autonomic, and experiential threat responses in posttraumatic stress disorder.

Dissociative symptoms, such as depersonalization and derealization, are experienced by about half of individuals with posttraumatic stress disorder (PTSD). Theoretical models propose that acute dissociation is accompanied by specific behavioral, physiological, and experiential alterations and contributes to unfavorable PTSD symptom course. Yet, empirical evidence is scarce. Here, we explored associations between dissociative and behavioral, physiological, and experiential threat responses as well as effects of dissociative responding on PTSD symptom course. Individuals with PTSD (N = 71) participated in a preregistered script-driven imagery study including exposure to standardized, detail-enriched trauma, and neutral scripts. Stabilometry, eye-tracking, facial electromyography, autonomic psychophysiology, and self-report data were collected. Moreover, PTSD symptoms were assessed before and 3 months after testing. Analyses did not link acute dissociation to bodily and facial immobility or staring in response to trauma scripts. However, dissociation displayed an inverted U-shaped relationship with heart rate and was linked to higher nonspecific skin conductance fluctuation and higher high-frequency heart rate variability in response to trauma scripts. Moreover, acute dissociation was linked to higher self-reported negative affect responses to trauma scripts and displayed a U-shaped relationship with unfavorable PTSD symptom course. While results did not confirm hypothesized behavioral markers of dissociation, they do support defense-cascade model assumptions of an inverted U-shaped relationship between dissociation and psychophysiological arousal resulting from a progression of parasympathetic versus sympathetic dominance with increasing dissociation. On an experiential level, results did not confirm posttraumatic dissociation-induced emotional numbing, questioning theoretical notions. The observed nonlinear associations may help explain the heterogeneity of prior findings and might inform an updated conceptualization of posttraumatic dissociation. (PsycInfo Database Record (c) 2023 APA, all rights reserved).

Dissociative symptoms among community health service users in Hong Kong: a longitudinal study of clinical course and consequences.

Background: Previous studies have demonstrated the high prevalence of dissociative symptoms and their association with considerable healthcare costs. However, there is a lack of studies that describe whether dissociative symptoms persist and lead to other clinical outcomes over time in the community.Objectives: This study investigated the persistence, predictors, and consequences of dissociative symptoms in the community.Methods: We analyzed longitudinal data in a sample of community health service users in Hong Kong (N = 173).Results: A relatively high proportion (63.6%) of participants with baseline dissociative symptoms continued to exhibit dissociative symptoms after approximately 9 months. Baseline non-betrayal trauma predicted subsequent dissociative symptoms (ß = .141, p = .024). Participants with baseline dissociative symptoms were more likely to have received subsequent emergency mental health services (9.1% vs 0.7%, p = .005). Baseline dissociative symptoms significantly predicted subsequent post-traumatic symptoms (ß = .165 to .191, p < .05) and difficulty in social and occupational participation (ß = -.152 to -.182, p < .05) even after controlling for baseline scores, trauma exposure, and use of professional support. The predictive role of dissociative symptoms on subsequent disturbances in self-organization symptoms and social participation difficulty remained significant after applying the Bonferroni correction.Conclusions: This is one of the very few studies showing that dissociative symptoms are persistent to a certain degree and could predict other symptoms and subsequent impairments even in community settings. Factors that affect the trajectory of dissociative symptoms should be further investigated. Regular screening for dissociative symptoms is recommended. Considering its prevalence, persistence, and clinical and social consequences, dissociation should be given greater public health attention.

Dissociative symptoms have been linked to considerable healthcare costs.The persistence and consequences of dissociation in the community had not been previously reported.This study showed that dissociative symptoms persisted to a certain degree and predicted subsequent impairments after approximately 9 months.Dissociation should be given greater public health attention.

Shame-induced dissociation: An experimental study of experiential avoidance.

OBJECTIVE: The study experimentally investigated shame-induced dissociation, and to what extent that process was associated with exposure to childhood maltreatment. METHOD: Using a shame-related script-driven imagery paradigm and mirror-viewing task, 50 female participants from the community recalled two shame-related and two neutral autobiographical memories, after which they listened to recordings of themselves retelling the narratives looking in a mirror or at a black curtain (i.e., mirror-viewing task). RESULTS: Shame-related memories compared to neutral memories resulted in higher rates of dissociation. The relationship between shame and dissociation was significantly moderated by experiential avoidance or avoidance of unwanted cognitive and affective reactions. In contrast to previous research, looking in the mirror and childhood maltreatment severity did not predict dissociative responses. CONCLUSIONS: The strong relationship between shame and dissociation suggests the importance of monitoring patients' affect and behavior when revisiting shame-related memories, to not reinforce dissociative reactions and inadvertently foster treatment resistance. (PsycInfo Database Record (c) 2023 APA, all rights reserved).

Women with PTSD and Substance Use Disorders in a Research Treatment Study: A Comparison of those with and without the Dissociative Subtype of PTSD.

Significant differences in clinical features have been reported in women with substance use disorders (SUDs) between those with the dissociative subtype of posttraumatic stress disorder (D-PTSD) compared to those without, namely more severe trauma histories, PTSD symptoms, and general psychopathology. This presentation reports on a group of 88 women with PTSD and SUD taking part in a research treatment study. All women were assessed using the Clinician Administered PTSD Scale for DSM-5 (CAPS-5) and were categorized into those with (n = 23, 26%) and without (n = 65, 74%) D-PTSD. Assessments for SUDs were via the Multi-International Neuropsychiatric Inventory, Seventh Version (MINI-7). Compared to those without D-PTSD, those with D-PTSD had significantly higher CAPS-5 scores (50.5 ± 9.9 v. 39.6 ± 8.8), greater number of PTSD symptoms (16.4 ± 2.6 v. 14.2 ± 2.4), more alcohol use disorder (AUD) (65.2% v. 30.8%), and more non-cocaine stimulant use disorder (34.8% v. 12.3%). No significant differences were found for other SUDs. These women with SUDs and D-PTSD have higher degrees of PTSD severity as well as unique clinical presentations. Future research is needed to explore the significance of these findings for clinical assessment and treatment.

Assessing responsiveness to direct verbal suggestions in depersonalization-derealization disorder.

The dissociative disorders and germane conditions are reliably characterized by elevated responsiveness to direct verbal suggestions. However, it remains unclear whether atypical responsiveness to suggestion is similarly present in depersonalization-derealization disorder (DDD). 55 DDD patients and 36 healthy controls completed a standardised behavioural measure of direct verbal suggestibility that includes a correction for compliant responding (BSS-C), and psychometric measures of depersonalization-derealization (CDS), mindfulness (FFMQ), imagery vividness (VVIQ), and anxiety (GAD-7). Relative to controls, patients did not exhibit elevated suggestibility (g = 0.26, BF10 = .11) but displayed significantly lower mindfulness (g = 1.38), and imagery vividness (g = 0.63), and significantly greater anxiety (g = 1.39). Although suggestibility did not correlate with severity of depersonalization-derealization symptoms in controls, r = -.03 [95% CI: -.36, .30], there was a weak tendency for a positive association in patients, r = .25, [95% CI: -.03, .48]. Exploratory analyses revealed that patients with more severe anomalous bodily experiences were also more responsive to suggestion, an effect not seen in controls. This study demonstrates that DDD is not characterized by elevated responsiveness to direct verbal suggestions. These results have implications for the aetiology and treatment of this condition, as well as its classification as a dissociative disorder in psychiatric nosology.

Corpus callosum size, hypnotic susceptibility and empathy in women with alleged mediumship: a controlled study.

AIM: Evidence indicates that highly hypnotizable subjects may have larger area of the rostrum of the corpus callosum (CC). Mediumship can be defined as the alleged ability to communicate regularly with deceased personalities, and self-hypnosis is postulated as an underlying mechanism for this ability. Therefore, we aimed to investigate the CC area, hypnotic susceptibility, self-reported dissociation, and empathy in alleged mediums in comparison with healthy, non-medium controls. METHODS: The study sample consisted of 16 Spiritist mediums (medium group (MG)) and 16 non-medium controls. Magnetic resonance imaging scans were performed to measure the CC areas (total and subdivisions). The Harvard Group Scale of Hypnotic Susceptibility was used to assess hypnotizability, and self-reported measures were used to investigate anomalous experiences, mental health using the Self-Reporting Questionnaire-SRQ, dissociative experiences using the Dissociative Experiences Scale, and empathy using the Interpersonal Reactivity Index. RESULTS: No between-group differences were found in the total or subdivided CC areas or in hypnotizability, with both groups showing intermediate levels. The rostrum of the CC area and hypnotizability were not correlated. The MG presented with significantly more anomalous experiences, but the two groups had similar scores for dissociation, empathy, and mental health. CONCLUSION: The normal CC areas found in the MG are in contrast with the abnormal results typically observed in subjects with psychotic and dissociative disorders. Although hypnotizability was not different between groups, further studies are needed to replicate these findings in other samples.

The varied relationship between hypnosis and dissociative phenomena: Implications for traumatology.

Although metanalytic evidence exists to support the long-term efficacy of hypnotic interventions in the treatment of trauma, assertions that hypnosis may induce trauma or exacerbate existing posttraumatic reactions through activating dissociative processes seem to persist in some circles. While multiple studies have established that hypnotic induction produces dissociative phenomena, what has not yet been clearly explicated is the degree to which varieties of dissociative phenomena differentially elicited by hypnotic induction tend to skew toward the pathological or nonpathological end of the continuum of dissociation. The authors of the current study explore the connection between hypnotic susceptibility and facets of dissociation, employing the Harvard Group Scale of Hypnotic Susceptibility: A (HGSHS:A) and the State Scale of Dissociation (SSD). A significantly greater change in state dissociation was observed in their hypnosis condition as compared with a novel control condition (t (82) = 3.235, p =.002, d =.70), confirming that a relationship appears to exist between hypnosis and dissociation. A discussion of the differential effect of hypnosis on SSD subscales follows, specifically indicating less activation of the more putatively pathological facets, namely identity confusion and identity alteration. This finding may serve to assuage some concerns around the potential for iatrogenesis in working with traumatized patients.

Styles of Experiencing Hypnosis: A Replication and Extension Study.

Beyond hypnotizability, there may be different styles of experiencing hypnosis relevant to both basic research and clinical practice. Previous research has demonstrated the presence of inward attentive and dissociative subtypes among more highly hypnotizable individuals during a group protocol. With a sample of undergraduate students, we successfully replicated the presence of these 2 subtypes among those who were relatively more hypnotizable. Inward attentive and dissociative subtypes did not differ in their overall experience of the depth of the relationship with the hypnotist, though the dissociative subjects reported elevated everyday dissociative experiences. We then explored features of each subtype, noting possible altered memory experience in the dissociative style and reduced experience of rationality in both the inward attentive and dissociative styles. We discuss the scientific and clinical implications of this line of research.

Anomalous experiences are more prevalent among highly suggestible individuals who are also highly dissociative.

Introduction: Predictive coding models propose that high hypnotic suggestibility confers a predisposition to hallucinate due to an elevated propensity to weight perceptual beliefs (priors) over sensory evidence. Multiple lines of research corroborate this prediction and demonstrate a link between hypnotic suggestibility and proneness to anomalous perceptual states. However, such effects might be moderated by dissociative tendencies, which seem to account for heterogeneity in high hypnotic suggestibility. We tested the prediction that the prevalence of anomalous experiences would be greater among highly suggestible individuals who are also highly dissociative.Methods: We compared high and low dissociative highly suggestible participants and low suggestible controls on multiple psychometric measures of anomalous experiences.Results: High dissociative highly suggestible participants reliably reported greater anomalous experiences than low dissociative highly suggestible participants and low suggestible controls, who did not significantly differ from each other.Conclusions: These results suggest a greater predisposition to experience anomalous perceptual states among high dissociative highly suggestible individuals.

Traditionality, Spirituality and Somatoform Dissociation Symptoms in Chinese Buddhists.

To evaluate the relationship between spiritual experience and hysterical experiences in Buddhist participants in ethnic groups in China, this cross-sectional study recruited 39 participants aged 16-57 years old, and self-administered surveys were administered in two villages, one city and one town by four research assistants in the Inner Mongolia and Qinhai areas. Binary logistic regression analyses were used to evaluate the factors associated with somatoform dissociation symptoms. Surveys were completed by 639 participants (mean age 31 years; 54.6% females) in 2017. Binary regression models showed that diverging from tradition and having a college education or above were associated with suffering from somatoform dissociation symptoms. By contrast, participants with higher experiences and older people were less likely to experience somatoform dissociation symptoms. Our current research highlights the contribution of spiritual experiences and traditional values to reducing somatization dissociation symptoms, and the findings could help to promote a new relationship between psychiatry and spiritual experiences that will benefit both mental health professionals and those who seek their assistance.

The Influence of Fantasy Proneness, Dissociation, and Vividness of Mental Imagery on Male's Aggressive Sexual Fantasies.

Many researchers have studied the prevalence and content of men's aggressive sexual fantasies, including their link with rape-supportive cognition. However, little to no research has examined the link between imaginal ability and the use of such fantasies. Based on existing research and theory, we propose that men who hold hostile beliefs toward women will use aggressive sexual fantasies more often if they possess a greater ability to engage in a "rich fantasy life." Operationally, we argue this involves (a) a proneness to fantasize in general, (b) an ability to vividly envision mental imagery, and (c) frequent experiences of dissociation. To test this, the present study hypothesized that a latent variable termed "rich fantasy life," via "hostile beliefs about women," influences the use of "aggressive sexual fantasies." A sample of 159 community males was recruited. Each participant completed a measure of fantasy proneness, dissociation, and vividness of mental imagery, along with two measures that assess hostile beliefs about women. Assessing how often the participants fantasized about rape-related and sadistic themes provided a measure of aggressive sexual fantasies. Structural equation modeling (along with bootstrapping procedures) indicated that the data had a very good fit with the hypothesized model. The results offer an important contribution to our understanding of aggressive sexual fantasies, which may have implications for clinical assessment and treatment. The limitations of the study are discussed, along with suggestions for future research.

Dissociative identity as a continuum from healthy mind to psychiatric disorders: Epistemological and neurophenomenological implications approached through hypnosis.

The topic of multiple personality, redefined as Dissociative Identity Disorders (DIDs) in the DSM-5, is an intriguing and still debated disorder with a long history and deep cultural and epistemological implications, extending up to the idea of possession. Hypnosis is an appealing and valuable model to manipulate subjective experience and get an insight on both the physiology and the pathophysiology of the mind-brain functioning; it and has been closely connected with DIDs and possession since its origin in 18th century and as recently proved the capacity to yield a loss of sense of agency, mimicking delusions of alien control and spirit possession. In this study we report on five very uncommon "hypnotic virtuosos" (HVs) free from any psychiatric disorder, spontaneously undergoing the emergence of multiple identities during neutral hypnosis; this allowed us to check the relationship between their experience and fMRI data. During hypnosis the subjects underwent spontaneous non-intrusive experiences of other selves which were not recalled after the end of the session, due to post-hypnotic amnesia. The fMRI showed a significant decrease of connectivity in the Default Mode Network (DMN) especially between the posterior cingulate cortex and the medial prefrontal cortex. Our results and their contrast with the available data on fMRI in DIDs allows to draw the hypothesis of a continuum between healthy mind - where multiple identities may coexist at unconscious level and may sometimes emerge to the consciousness - and DIDs, where multiple personalities emerge as dissociated, ostensibly autonomous components yielding impaired functioning, subject's loss of control and suffering. If this is the case, it seems more reasonable to refrain from seeking for a clear-cut limit between normality (anyway a conventional, statistical concept) and pathology, and accept a grey area in between, where ostensibly odd but non-pathological experiences may occur (including so-called non-ordinary mental expressions) without calling for treatment but, rather, for being properly understood.

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.

CAN SUBJECTIVE RATINGS OF ABSORPTION, DISSOCIATION, AND TIME PERCEPTION DURING "NEUTRAL HYPNOSIS" PREDICT HYPNOTIZABILITY?: An exploratory study.

This study explored absorption, dissociation, and time perception on visual analogue scales (VAS) after a neutral hypnosis session to predict hypnotizability. Sixty-two subjects completed the Stanford Hypnotic Susceptibility Scale, Form C (SHSS:C) and, during a neutral hypnosis session, VAS ratings of absorption, dissociation, and time perception. The findings indicated that 44% of subjects scored high, 35% medium, and 21% low on hypnotizability, as determined by scores on the SHSS:C. Dissociation VAS ratings significantly differed when comparing low to high and medium to high hypnotizable subjects. However, ratings were not significantly different between medium and low subjects. Significant positive correlation was found between dissociation VAS ratings and SHSS:C total scores. Future research is needed to validate this proof-of-concept study.

Reconsidering the autohypnotic model of the dissociative disorders.

The dissociative disorders field and the hypnosis field currently reject the autohypnotic model of the dissociative disorders, largely because many correlational studies have shown hypnotizability and dissociation to be minimally related (r = .12). Curiously, it is also widely accepted that dissociative patients are highly hypnotizable. If dissociative patients are highly hypnotizable because only highly hypnotizable individuals can develop a dissociative disorder - as the author proposes - then the methodology of correlational studies of hypnotizability and dissociation in random clinical and community samples would necessarily be constitutively unable to detect, and statistically unable to reflect, that fact. That is, the autohypnotic, dissociative distancing of that small subset of highly hypnotizable individuals who repeatedly encountered intolerable circumstances is statistically lost among the data of (1) the highly hypnotizable subjects who do not dissociate and (2) subjects (of all levels of hypnotizability) who manifest other kinds of dissociation. The author proposes that, when highly hypnotizable individuals repeatedly engage in autohypnotic distancing from intolerable circumstances, they develop an overlearned, highly-motivated, automatized pattern of dissociative self-protection (i.e., a dissociative disorder). The author urges that theorists of hypnosis and the dissociative disorders explicitly include in their theories (a) the trait of high hypnotizability, (b) the phenomena of autohypnosis, and (c) the manifestations of systematized, autohypnotic pathology. Said differently, the author is suggesting that autohypnosis and autohypnotic pathology are unacknowledged nodes in the nomothetic networks of both hypnosis and dissociation.

What Mindfulness can learn about Dissociation and what Dissociation can learn from Mindfulness.

Mindfulness based psychotherapeutic interventions have shown to be an effective intervention for quite some time now. These intervention, however, have not been that successful with individuals who experience dissociative disorders. There is a very clear disconnect between these two fields. In an attempt to close the gap, reviewing what mindfulness might be from an attachment and human developed lens, one can learn that there is a lot more occurring in a mindful state other than relaxation. There is a level of human development achievement that comes from a regular mindfulness practice that seems to play a role in raising our young and being part of a complex social group. Evidence suggests that the end product of mindfulness is likely deeply connected human relationships and balanced care-giving abilities. In knowing the benefits from a relational perspective of mindfulness those in the dissociative world can utilize adaptations of mindfulness so that their clients can eventually learn to developed mindfulness and, in turn, have the same deeply connected relationship that they often missed. Conversely those in the mindfulness based therapeutic world can learn a lot about dissociation and harmed people by understanding the real difficulties that individuals with dissociative disorders have in experiencing a mindful state. They can learn to understand the need to adapt mindfulness based practices to accommodate individuals who have a system that is phobic of awareness, terrified of being calm and who have no concept of what non-judgement means. Both fields would benefit greatly by knowing more about the other.

[Inpatient Treatment of Complex PTSD Following Childhood Abuse: Effectiveness and Predictors of Treatment Outcome]. / Stationäre Therapie der komplexen PTBS in Folge körperlicher oder sexualisierter Gewalt in der Kindheit: Wirksamkeit und Prädiktoren des Behandlungsverlaufs.

BACKGROUND: There is a lack of studies investigating the effectiveness of inpatient trauma-focused psychotherapy of complex post-traumatic stress disorder. The first aim of this retrospective investigation was to analyze the course of PTSD. Second, possible predictors of treatment response were investigated. METHODS: 150 inpatients of Clinic St. Irmingard with complex PTSD following childhood physical and childhood sexual abuse were assessed regarding childhood abuse, PTSD symptomatology, mindfulness, dissociation and general psychopathology. Differences in pre and post scores were analyzed using regression analyses. A classification tree was used to identify predictors of response. RESULTS: The significant reduction of PTSD symptoms corresponded to a large effect (d=1.8) and a reponse rate of 52% according to the reliable change index (p<0.05). Effect sizes for other symptoms were medium to large (0.5

[Ego-state Therapy: Psychotherapy for Multiple Personality Disorders].

The author describes ego-state therapy. This psychotherapy is used for treating multiple personality disorders. The author mentions the theoretical background of this method, and practical points. Initially, ego-state therapy was developed as a type of hypnotherapy, but it evolved as a safe therapeutic method in combination with trauma processing therapies. The author presents a case study, and discusses the clinical significance of this treatment.