Incestuous Abuse Continuing into Adulthood: Clinical Features and Therapists' Conceptualisations.

Prolonged incest, where children are sexually abused by familial perpetrators into adulthood, has been documented in clinical and criminological scholarship, however it is often overlooked in research, policy and practice approaches to familial sexual abuse. This article draws on interviews with ten Australian therapists about their clinical work with clients subject to incestuous abuse continuing into adulthood. It outlines their descriptions of these cases, the nature of the reported abuse and factors that facilitated prolonged and ongoing incest, including at the time of therapy. The therapists and their clients were female. The clients were highly dissociative and experienced significant psychiatric and medical comorbidity, and extensive socio-economic disadvantage. Reported abuse was sadistic, ongoing, often involved multiple perpetrators, and sometimes had links to organized abuse. Therapists' conceptualizations of the factors related to the abuse included: enmeshed and disorganized attachment to the perpetrator; symptoms of severe dissociation; having absent, abusive or non-protective mothers; and social isolation which limited help-seeking. The study concludes that attachment, trauma and dissociation-informed therapy is essential, while further research is needed to further explore effective interventions and responses to this clinical cohort.

A comparison between auditory hallucinations, interpretation of voices, and formal thought disorder in dissociative identity disorder and schizophrenia spectrum disorders.

OBJECTIVES: Dissociative identity disorder (DID) and schizophrenia-spectrum disorders (SSD) share some overlapping phenomenological features making accurate diagnosis more difficult. Childhood abuse and depersonalization have been associated with psychotic symptoms across psychological disorders but their relationship to psychotic phenomenology remains understudied. METHOD: The present study used quantitative measures to examine (1) similarities and differences in phenomenological voice hearing experiences, interpretations of voices, and thought disorder symptoms in individuals with DID (n = 44) or SSD (n = 45), and (2) whether depersonalization and childhood maltreatment influenced the initial pattern of findings. RESULTS: DID participants perceived their voices as being more internally located and generated, louder, and uncontrollable than SSD participants. Furthermore, the DID participants endorsed a greater frequency of thought disorder symptoms. Adding the covariates (sex, depersonalization, and child maltreatment) did not change the findings associated with location and origin of voices, and derailment, but there were now no differences in loudness or controllability. However, the schizophrenia sample reported more distress and metaphysical beliefs associated with voices, as well as more thought disorder incoherence and word substitution with the covariates controlled. CONCLUSION: While tentative, metaphysical interpretations of voices, incoherent thoughts and word substitution may reflect more psychotic processes.

Dissociation-Induced Shame in Those with a Dissociative Disorder: Assessing the Impact of Relationship context using Vignettes.

Some evidence in non-clinical groups suggests that the relationship context in which dissociation is experienced might moderate its association with shame. The current study used vignettes detailing either dissociative symptoms or the expression of sadness occurring in three different relationship contexts: with a friend, an acquaintance, or when alone. Ratings of emotional (e.g. shame, anxiety) and behavioral (e.g. leave, talk) reactions were made on single-item measures, and shame feelings were further assessed with the State Shame Scale. Participants were in treatment for either dissociative identity disorder (n = 31) or other specified dissociative disorder (n = 3; N = 34). Feelings of shame were elevated in the acquaintance condition compared to when with a close friend or alone regardless of whether dissociation or sadness was experienced. In the acquaintance context, participants exposed to dissociation or sadness reported feeling annoyed at themselves, having a greater desire to leave, and a lesser desire to talk compared to when these experiences happened with a close friend or alone. Results suggest those with a dissociative disorder appraise themselves as more vulnerable to shame if experiencing dissociation or sadness when with an acquaintance, potentially because the risk of not being understood and rejected is heightened.

The Dissociation-Related Beliefs About Memory Questionnaire (DBMQ): Development and psychometric properties.

OBJECTIVE: Discontinuities in memory are the hallmark symptoms of most dissociative disorders but are also reported by patients diagnosed with related disorders, including PTSD. Memory discontinuity is most evident in dissociative identity disorder (DID), where patients may report amnesia in 1 identity for information available in other identities (i.e., interidentity amnesia). Studies indicate that even though patients subjectively report interidentity amnesia for material learned in, or pertaining to, another identity, objective findings show evidence of transfer of that material between identities. Subjective reports of dissociative amnesia may be explained by specific dissociation-related metamemory beliefs, which hinder voluntary retrieval, personal acknowledgment, and processing of memories. This study aimed to develop a questionnaire indexing metamemory beliefs related to trait dissociation. METHOD: Two studies in nonclinical populations provided information about the factor structure (Studies 1 and 2) of the newly developed Dissociation-related Beliefs about Memory Questionnaire (DBMQ). Information was also provided about the construct validity (Studies 2 and 3), and reliability of the scale (all 3 studies) in nonclinical as well as a clinical population. RESULTS: Results indicated sound psychometric properties of a short 16-item DBMQ with subscales assessing Fragmentation, Positive beliefs about amnesia, Lack of self-reference, and Fear of losing control, and correlations specifically with trait dissociation and posttraumatic avoidance symptoms. A sample of DID patients (N = 19) showed increased scores on the DBMQ. CONCLUSION: The DBMQ provides a short, reliable, and valid tool for indexing dissociation-related metamemory beliefs. These beliefs were associated with trait dissociation and posttraumatic avoidance symptoms. (PsycInfo Database Record (c) 2023 APA, all rights reserved).

Dissociation as a Mediator Between Childhood Abuse and Hallucinations: An Exploratory Investigation Using Dissociative Identity Disorder and Schizophrenia Spectrum Disorders.

Previous research has shown that the relationship between childhood abuse and the presence of auditory hallucinations is mediated by dissociation, specifically depersonalization and absorption. The current study assessed dissociation as a mediator of the relationship between childhood abuse and auditory hallucination frequency, characteristics and associated distress in those with dissociative identity disorder (DID; n = 50) and schizophrenia spectrum disorders (SSD; n = 49). It also tested whether dissociation mediated the relationship between childhood abuse and the presence of non-auditory hallucinations. Participants completed measures of childhood abuse, dissociation, auditory hallucination frequency, characteristics, distress, and non-auditory hallucinations. With distress associated with auditory hallucinations as the outcome, depersonalization was a mediator in the DID group. For non-auditory hallucinations, in the DID group depersonalization and amnesia were mediators between childhood abuse and the presence of visual, tactile and olfactory hallucinations. In the SSD group absorption mediated between childhood abuse and visual, olfactory and gustatory hallucinations. Results suggest that the presence of non-auditory hallucinations in DID and SSD are associated with different dissociative experiences.

"The History And Politics Of 'False Memories': The Australian Experience".

The Australian history of the false memory (FM) movement has similarities to that of the UK and America, but also important differences that are rarely described in the literature. This article, through an examination of cross-discipline professional literature, media reports, and the personal observations of the second author, describes the history of the FM Movement in Australia and outlines similarities and differences between Australia, the UK and America. All three countries experienced the establishment of false memory syndrome (FMS) societies and a backlash against those reporting or treating child sexual abuse (CSA). However, in Australia the backlash was notably smaller and led to a different trajectory for those reporting CSA, particularly institutional abuse. The authors propose that this is due to differences in the media and legal systems; the later timing of the backlash in Australia; and a more muted reporting of satanic ritual abuse (SRA), which avoided the extreme disbelief and backlash that occurred in other countries.

Childhood Sexual, Emotional, and Physical Abuse as Predictors of Dissociation in Adulthood.

This Australian study explores a person's self-reported exposure to childhood abuse to identify the characteristics that are predictive of clinical levels of dissociation in adulthood. The final sample comprised 303 participants, including 26 inpatients and outpatients (24 females and two males) receiving treatment for a dissociative disorder (DD), and 277 university participants, including 220 controls (186 females, 34 males), 31 with elevated levels of dissociation consistent with a DD or posttraumatic stress disorder (27 females and four males), and 26 with clinical levels of dissociation (20 females and six males). The findings demonstrate clinical levels of dissociation and DDs occur in individuals reporting a history of childhood abuse, particularly sexual abuse and experiences that are potentially life-threatening to a child, such as choking, smothering, and physical injury that breaks bones or teeth, or that compromise the child's survival needs, including threats of abandonment and deprivation of basic needs. Females who disclosed being sexual abused in addition to being choked or smothered had a 106-fold risk of clinical levels of dissociation. As expected, self-reported amnesia was prevalent in the dissociative groups. Yet, even in the control group, one-third of those disclosing sexual abuse reported an unclear memory of it. Strong similarities in abuse experiences were found between the clinical sample and those in the university sample with clinical levels of dissociation (which is unlikely to have previously been diagnosed). The dissociative groups reported higher rates of corroboration of their abusive experiences. The findings support the traumatic etiology of dissociation.

The Sense of Self Over Time: Assessing Diachronicity in Dissociative Identity Disorder, Psychosis and Healthy Comparison Groups.

Dissociative experiences have been associated with diachronic disunity. Yet, this work is in its infancy. Dissociative identity disorder (DID) is characterized by different identity states reporting their own relatively continuous sense of self. The degree to which patients in dissociative identity states experience diachronic unity (i.e., sense of self over time) has not been empirically explored. This study examined the degree to which patients in dissociative identity states experienced diachronic unity. Participants were DID adults (n=14) assessed in adult and child identity states, adults with a psychotic illness (n=19), adults from the general population (n=55), children from the general population (n=26) and adults imagining themselves as children (n=23). They completed the Diachronic Disunity Scale (DDS), the Dissociative Experiences Scale (DES), and the Self-Concept Clarity Scale (SCCS). Diachronic disunity was not limited to psychiatric groups, but evident to some degree in all adult and child samples. The DID adult sample experienced more dissociation and self-confusion than the psychosis and adult comparison groups, but did not differ on the diachronic measure. DID patients in their child identity states and child comparisons showed disunity and were significantly different from child simulators, who showed relatively more unity. Results suggest that DID patients in either adult or child dissociative identity states, like those in other samples, do not universally experience themselves as having a consistent sense of self over time.

Inter-identity amnesia for neutral episodic self-referential and autobiographical memory in Dissociative Identity Disorder: An assessment of recall and recognition.

Amnesia is a core diagnostic criterion for Dissociative Identity Disorder (DID), however previous research has indicated memory transfer. As DID has been conceptualised as being a disorder of distinct identities, in this experiment, behavioral tasks were used to assess the nature of amnesia for episodic 1) self-referential and 2) autobiographical memories across identities. Nineteen DID participants, 16 DID simulators, 21 partial information, and 20 full information comparison participants from the general population were recruited. In the first study, participants were presented with two vignettes (DID and simulator participants received one in each of two identities) and asked to imagine themselves in the situations outlined. The second study used a similar methodology but with tasks assessing autobiographical experience. Subjectively, all DID participants reported amnesia for events that occurred in the other identity. On free recall and recognition tasks they presented a memory profile of amnesia similar to simulators instructed to feign amnesia and partial information comparisons. Yet, on tests of recognition, DID participants recognized significantly more of the event that occurred in another identity than simulator and partial information comparisons. As such, results indicate that the DID performance profile was not accounted for by true or feigned amnesia, lending support to the idea that reported amnesia may be more of a perceived than actual memory impairment.

Measuring Dissociative Symptoms and Experiences in an Australian College Sample Using a Short Version of the Multidimensional Inventory of Dissociation.

This paper investigated a 60-item version of the Multidimensional Inventory of Dissociation (MID) with the potential to capture the full range of dissociative symptoms that characterize each of the dissociative disorders (DD). The 28-item Dissociative Experiences Scale (DES) was designed to capture a wide range of dissociative phenomena, but college population studies indicate it may not be adept at identifying the full range of dissociative symptoms and disorders. The 218-item MID has the advantage of capturing the full range of dissociative symptoms and has diagnostic capabilities for all DSM-5 DD, but the disadvantage of taking considerably longer than the DES to complete. Using university students and staff (N = 313), this paper investigated a 60-item version of the MID with the potential to capture the full range of dissociative symptoms that characterize each of the DD. Results indicate the MID-60 has a nearly identical factor structure to the full MID, excellent internal reliability, and content and convergent validity. Using the MID-60, at least 8% of participants at an Australian university were positive for a DD and, on average, participants self-reported having dissociative experiences 13% of the time. The present study's findings suggest the MID-60 is a promising alternative to the DES, with results about the prevalence of DDs and dissociative experiences consistent with those found using clinical interviews and the DES.

Delusional beliefs and their characteristics: A comparative study between dissociative identity disorder and schizophrenia spectrum disorders.

Firmly held beliefs that have a delusional quality are commonly experienced in those with schizophrenia spectrum disorders (SSD) and have been reported in those with dissociative identity disorder (DID). However, no study to date has compared delusional belief content and characteristics between these diagnostic groups. This study examined delusional content, and the degree of conviction, preoccupation and distress associated with them in 50 participants with DID and 50 with an SSD exploring also dissociation and childhood trauma as predictors of delusional beliefs. Multivariate analysis of variance and linear regressions were conducted to explore differences between beliefs and characteristics and to examine their association with dissociation and childhood trauma. The SSD sample presented more self-referential delusional beliefs and characteristics compared to the DID group. Yet, the DID group had more mistrust delusional beliefs and characteristics in comparison to SSD participants. Mistrust beliefs were predicted by depersonalization/derealization in the DID sample, but did not predict any delusional belief in the SSD sample. The content of fixed beliefs differs between DID and SSD samples and in this study depersonalization/derealization experiences were related to mistrust beliefs but not to other delusional forms, and only in the DID sample.

The Detachment and Compartmentalization Inventory (DCI): An assessment tool for two potentially distinct forms of dissociation.

While evidence suggests a division between two qualitatively distinct forms of dissociation, no scale has been specifically designed to differentiate between them. This study describes the development and validation of the Detachment and Compartmentalization Inventory (DCI). The DCI was developed from dissociation theory, 29 existing dissociation scales and expert opinion. An initial pilot study was conducted which assessed readability, explored validity and reduced items before the DCI was administered online to 89 nonclinical and 105 clinical participants. The Dissociative Experiences Scale (DES), Somatoform Dissociation Questionnaire (SDQ), and Mindfulness Attention Awareness Scale (MAAS) were included in the survey battery. The DCI exhibited good internal reliability, discriminant validity, convergent validity, construct validity and concurrent validity. The final version containing 22-items, is self-administered, grounded in the theoretical literature and supported by initial psychometric evaluation. It has 10 items assessing compartmentalization, 10 items assessing detachment and two items examining valid responding. The DCI could detect compartmentalization and detachment, and was designed for clinical research and for screening patients.

Transfer of episodic self-referential memory across amnesic identities in dissociative identity disorder using the Autobiographical Implicit Association Test.

Individuals with dissociative identity disorder (DID) often report having no access to autobiographical experiences encoded by other identities. This research used the autobiographical Implicit Association Test (aIAT) to determine whether there was transfer of episodic self-referential memory events across amnesic identities. Nineteen DID individuals, 16 DID simulators, and 41 comparison participants (divided into amnesic and nonamnesic groups) engaged with an audio vignette of embarrassing scenarios to produce the experience of episodic self-referential events. Results showed transfer of episodic self-referential memory using the aIAT across identities that reported no conscious awareness of encoded content in DID. These aIAT results in DID patients were similar to the nonamnesic comparison group and the simulator group, and differed from the amnestic comparison group. These results are in line with previous literature showing transfer of memories, but extends this work to episodic self-referential memory. (PsycINFO Database Record (c) 2018 APA, all rights reserved).

Engendered Responses to, and Interventions for, Shame in Dissociative Disorders: A Survey and Experimental Investigation.

This study examined shame and responses to it in adult dissociative disorder (DD; n = 24) and comparison psychiatric (n = 14) samples. To investigate how helpful different therapeutic responses are after shame disclosures in therapy, participants heard two vignettes from "mock" patients disclosing a) shame and b) surprise. Participants rated the helpfulness of five potential responses. Interventions covered withdrawing from the affect (withdrawal focused) to feeling it (feeling focused), with other interventions on cognitions (cognitive focused), management strategies (management focused), and previous experiences (history focused). The DD sample reported higher characterological and bodily shame, and more shame avoidance and withdrawal. There was no difference across groups for intervention ratings. For shame, interventions focused on feelings, cognitions, or previous shame experiences were deemed most helpful, but this was qualified by experiencing dissociation while hearing the script, where the history intervention was reported less helpful. Exposure to shame while monitoring dissociation should accompany therapy for DDs.

Shame, Dissociation, and Complex PTSD Symptoms in Traumatized Psychiatric and Control Groups: Direct and Indirect Associations With Relationship Distress.

OBJECTIVES: Elevated shame and dissociation are common in dissociative identity disorder (DID) and chronic posttraumatic stress disorder (PTSD) and are part of the constellation of symptoms defined as complex PTSD. Previous work examined the relationship between shame, dissociation, and complex PTSD and whether they are associated with intimate relationship anxiety, relationship depression, and fear of relationships. This study investigated these variables in traumatized clinical samples and a nonclinical community group. METHOD: Participants were drawn from the DID (n = 20), conflict-related chronic PTSD (n = 65), and nonclinical (n = 125) populations and completed questionnaires assessing the variables of interest. A model examining the direct impact of shame and dissociation on relationship functioning, and their indirect effect via complex PTSD symptoms, was tested through path analysis. RESULTS: The DID sample reported significantly higher dissociation, shame, complex PTSD symptom severity, relationship anxiety, relationship depression, and fear of relationships than the other two samples. Support was found for the proposed model, with shame directly affecting relationship anxiety and fear of relationships, and pathological dissociation directly affecting relationship anxiety and relationship depression. The indirect effect of shame and dissociation via complex PTSD symptom severity was evident on all relationship variables. CONCLUSION: Shame and pathological dissociation are important for not only the effect they have on the development of other complex PTSD symptoms, but also their direct and indirect effects on distress associated with relationships.

Extreme adaptations in extreme and chronic circumstances: The application of "weaponized sex" to those exposed to ongoing incestuous abuse.

This paper examines Kluft's construct of "weaponized sex" through the prism of long-term clinical and research involvement with individuals subjected to ongoing sexual abuse during adulthood, a group that by definition has been exposed to more sexual abuse and for longer than any other defined victim population. Examples of the same sort of phenomena described by Kluft are repeatedly observed in therapy with members of this population, but usually not in a dramatic form. As might be anticipated, in order to survive, when an individual is closely attached to a long-term and extreme abuser, the sort of enduring ambivalence carried by the victim towards their primary abuser is manifested in compartmentalized states that wish their abuser dead, while other states in equally compartmentalized ways maintain the attachment via the use of sex-by continuing to be sexually involved with their primary abuser (usually their father), by fantasizing about sex with their abuser, by being sexually involved with those who co-abused with their father, or by staging reenactments with individuals whose sexual behavior re-evokes the abuse by the absent (or deceased) father. The process of healing means that inevitably some manifestations of the responses to such abuse spill over into therapy.

Comparing shame in clinical and nonclinical populations: Preliminary findings.

OBJECTIVES: To conduct a preliminary study comparing different trauma and clinical populations on types of shame coping style and levels of state shame and guilt. METHODS: A mixed independent groups/correlational design was employed. Participants were recruited by convenience sampling of 3 clinical populations-complex trauma (n = 65), dissociative identity disorder (DID; n = 20), and general mental health (n = 41)-and a control group of healthy volunteers (n = 125). All participants were given (a) the Compass of Shame Scale, which measures the four common shame coping behaviors/styles of "withdrawal," "attack self," "attack other," and "avoidance," and (b) the State Shame and Guilt Scale, which assesses state shame, guilt, and pride. RESULTS: The DID group exhibited significantly higher levels of "attack self," "withdrawal," and "avoidance" relative to the other groups. The complex trauma and general mental health groups did not differ on any shame variable. All three clinical groups had significantly greater levels of the "withdrawal" coping style and significantly impaired shame/guilt/pride relative to the healthy volunteers. "Attack self" emerged as a significant predictor of increased state shame in the complex trauma, general mental health, and healthy volunteer groups, whereas "withdrawal" was the sole predictor of state shame in the DID group. CONCLUSIONS: DID emerged as having a different profile of shame processes compared to the other clinical groups, whereas the complex trauma and general mental health groups had comparable shame levels and variable relationships. These differential profiles of shame coping and state shame are discussed with reference to assessment and treatment. (PsycINFO Database Record

The role of clinical experience, diagnosis, and theoretical orientation in the treatment of posttraumatic and dissociative disorders: A vignette and survey investigation.

Controversy exists regarding the merits of exposure-based treatments for posttraumatic stress disorder (PTSD) versus a phased approach when prominent dissociative symptoms are present. The first aim of this study was to examine the degree to which diagnosing dissociation in two traumatized patients' vignettes influenced clinicians' preference for phase-oriented treatment and whether clinicians' treatment experience contributed to their treatment preference. The second aim was to assess the extent to which participants had observed traumatized patients worsen when treated with exposure therapy or phase-oriented therapy and whether the theoretical orientation and treatment experience of the clinician were related to the observed deterioration. In the tradition of expert and practitioner surveys, 263 clinicians completed a survey of their diagnoses and treatment preferences for two vignettes and their treatment experience, theoretical orientation, and observations of patients' deterioration. When a marked degree of dissociation was noted in the PTSD vignette, respondents favored phased approaches regardless of the diagnosis given. Reports of having observed patient deterioration during both exposure and phased therapy were predicted by years of experience. Psychodynamic therapists reported more observations of worsening during exposure therapy than cognitive behavior therapy therapists. Clinical experience treating PTSD may heighten awareness of negative therapeutic effects, potentially because experienced clinicians have a lower threshold for detecting such effects and because they are referred more challenging cases.

Separating Fact from Fiction: An Empirical Examination of Six Myths About Dissociative Identity Disorder.

Dissociative identity disorder (DID) is a complex, posttraumatic, developmental disorder for which we now, after four decades of research, have an authoritative research base, but a number of misconceptualizations and myths about the disorder remain, compromising both patient care and research. This article examines the empirical literature pertaining to recurrently expressed beliefs regarding DID: (1) belief that DID is a fad, (2) belief that DID is primarily diagnosed in North America by DID experts who overdiagnose the disorder, (3) belief that DID is rare, (4) belief that DID is an iatrogenic, rather than trauma-based, disorder, (5) belief that DID is the same entity as borderline personality disorder, and (6) belief that DID treatment is harmful to patients. The absence of research to substantiate these beliefs, as well as the existence of a body of research that refutes them, confirms their mythical status. Clinicians who accept these myths as facts are unlikely to carefully assess for dissociation. Accurate diagnoses are critical for appropriate treatment planning. If DID is not targeted in treatment, it does not appear to resolve. The myths we have highlighted may also impede research about DID. The cost of ignorance about DID is high not only for individual patients but for the whole support system in which they reside. Empirically derived knowledge about DID has replaced outdated myths. Vigorous dissemination of the knowledge base about this complex disorder is warranted.