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 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.

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.

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.

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 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.

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.

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.

Child abuse and neglect in complex dissociative disorder, abuse-related chronic PTSD, and mixed psychiatric samples.

Only a select number of studies have examined different forms of child maltreatment in complex dissociative disorders (DDs) in comparison to other groups. Few of these have used child abuse-related chronic posttraumatic stress disorder (C-PTSD) and mixed psychiatric (MP) patients with maltreatment as comparison groups. This study examined child sexual, physical, and emotional abuse as well as physical and emotional neglect in DD (n = 39), C-PTSD (n = 13), and MP (n = 21) samples, all with abuse and neglect histories. The predictive capacity of these different forms of maltreatment across the 3 groups was assessed for pathological dissociation, shame, guilt, relationship esteem, relationship anxiety, relationship depression, and fear of relationships. All forms of maltreatment differentiated the DD from the MP group, and sexual abuse differentiated the DD sample from the C-PTSD group. Childhood sexual abuse was the only predictor of pathological dissociation. Emotional abuse predicted shame, guilt, relationship anxiety, and fear of relationships. Emotional neglect predicted relationship anxiety and relationship depression. Physical neglect was associated with less relationship anxiety. Different forms of abuse and neglect are associated with different symptom clusters in psychiatric patients with maltreatment histories.

Dissociative identity disorder: An empirical overview.

OBJECTIVE: Despite its long and auspicious place in the history of psychiatry, dissociative identity disorder (DID) has been associated with controversy. This paper aims to examine the empirical data related to DID and outline the contextual challenges to its scientific investigation. METHODS: The overview is limited to DID-specific research in which one or more of the following conditions are met: (i) a sample of participants with DID was systematically investigated, (ii) psychometrically-sound measures were utilised, (iii) comparisons were made with other samples, (iv) DID was differentiated from other disorders, including other dissociative disorders, (v) extraneous variables were controlled or (vi) DID diagnosis was confirmed. Following an examination of challenges to research, data are organised around the validity and phenomenology of DID, its aetiology and epidemiology, the neurobiological and cognitive correlates of the disorder, and finally its treatment. RESULTS: DID was found to be a complex yet valid disorder across a range of markers. It can be accurately discriminated from other disorders, especially when structured diagnostic interviews assess identity alterations and amnesia. DID is aetiologically associated with a complex combination of developmental and cultural factors, including severe childhood relational trauma. The prevalence of DID appears highest in emergency psychiatric settings and affects approximately 1% of the general population. Psychobiological studies are beginning to identify clear correlates of DID associated with diverse brain areas and cognitive functions. They are also providing an understanding of the potential metacognitive origins of amnesia. Phase-oriented empirically-guided treatments are emerging for DID. CONCLUSIONS: The empirical literature on DID is accumulating, although some areas remain under-investigated. Existing data show DID as a complex, valid and not uncommon disorder, associated with developmental and cultural variables, that is amenable to psychotherapeutic intervention.

"Holding the badness": Therapists' experiences of treating incestuous abuse continuing into adulthood.

OBJECTIVE: This study aimed to explore the experience of therapists whose clients report incestuous abuse continuing into adulthood. METHOD: Ten Australian therapist-participants were recruited through professional forums. After giving informed consent, they completed a semistructured interview. Therapists were asked about their experiences of providing therapy to people who disclosed incestuous abuse that continued into adulthood and their experiences of training, peer support, and supervision in relation to these cases. The interviews were recorded, transcribed, labeled with a pseudonym, and deidentified. The transcripts were subjected to reflexive thematic analysis (TA) following the guidelines of Braun and Clarke (2006, 2022). RESULTS: The study found that three overarching themes described the therapeutic experience and response to this client group: (1) the therapist's emotional distress, vicarious traumatization, and moral injury at the extent of abuse and suffering disclosed by the client; (2) the need to adjust therapeutic goals and their reactions to this; and (3) feelings of professional isolation and a lack of support within mainstream services. CONCLUSIONS: The study describes therapeutic experience of a sample of practitioners and concludes that this work is distressing and demanding, requiring therapists to find their own coping methods, training, and supervision. The study points to needs for changes in practitioner training, service delivery, and policy to enable more holistic care of clients reporting complex ongoing abuse. (PsycInfo Database Record (c) 2024 APA, all rights reserved).

Parent-child incest that extends into adulthood: a survey of international press reports, 2007-2011.

Although the subject of ongoing incestuous abuse during adulthood has never been addressed in a systematic way in the professional literature, accounts of such cases have been appearing for many years. The Josef Fritzl case added a new impetus to reporting such abuses in the popular press. The current study presents 44 such cases from 24 countries that appeared in English-language press accounts over 5 years commencing January 2007. These cases are discussed in light of the minimal coverage of such issues in the professional literature. The results of this study suggest that cases of enduring incest are not rare and typically incorporate decades of sexual abuse, frequently result in pregnancies, and commonly incorporate ongoing violence and death threats.

Ongoing incestuous abuse during adulthood.

Individual cases of adult incestuous abuse have surfaced repeatedly in the lay and professional literature of the past 1.5 centuries without it occasioning systematic investigation, such as the reporting of a case series of individuals subjected to such extreme abuse. Yet substantial numbers of patients with dissociative identity disorder at the time of presentation report incestuous abuse continuing into the adult years, and for many the abuse is ongoing. Data relating to a series of 10 such incestuously abused women are presented. These patients were sexually abused from a very early age (typically from before age 3), with the manipulation of their sexual response a key component in conditioning an enduring sexualized attachment. Shame and fear were also used to ensure compliance and silence. The women, when able to speak of it, describe the induction by their paternal abuser of orgasm at an early age, typically around the age of 6. The women have high indices of self-harm and suicidality and are prone to placing themselves in dangerous reenactment scenarios. The average duration of incestuous abuse for this group of women was 31 years, and the average estimate of total episodes of sexual abuse was 3,320. Most women do not feel that they own their body and experience being "fused" to their father. Their mother was reported as an active participant in the sexual abuse or as having done nothing to protect their daughter despite seeing obvious evidence of incest. The fathers, despite a propensity to use or threaten violence, were generally outwardly productively employed, financially comfortable, and stably married and half had close church involvement. However, suicide and murder occurred within the 1st- or 2nd-degree relatives of these women at a high frequency. All 10 had been sexually abused by various groupings of individuals connected to their fathers.

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).

Successful psychotherapy for psychogenic seizures in men.

This qualitative study examined factors contributing to the development and successful treatment of psychogenic non-epileptic seizures (PNES), in civilian men. In-depth interviews were conducted with therapist-client dyads comprising two male clients who had been successfully treated for PNES and their therapists. A theory-building case study approach provided evidence that those factors known to contribute to PNES and other somatoform symptoms in females and in males engaged in war also contributed to these symptoms in these two civilian males. In addition, PNES in these civilian males occurred in contexts where masculine identity was developmentally curtailed and socially constrained. Successful treatments occurred in long-term therapeutic relationships that sanctioned verbal expression of strong emotion and provided the attunement necessary for development of a robust masculine identity. These findings have implications for the funding of therapy, and training of therapists.