Five lessons on dissociation

Titolo Rivista RIVISTA SPERIMENTALE DI FRENIATRIA
Autori/Curatori Adriano Schimmenti
Anno di pubblicazione 2018 Fascicolo 2018/1 Lingua Inglese
Numero pagine 19 P. 73-91 Dimensione file 1750 KB
DOI 10.3280/RSF2018-001005
Il DOI è il codice a barre della proprietà intellettuale: per saperne di più clicca qui

Qui sotto puoi vedere in anteprima la prima pagina di questo articolo.

Se questo articolo ti interessa, lo puoi acquistare (e scaricare in formato pdf) seguendo le facili indicazioni per acquistare il download credit. Acquista Download Credits per scaricare questo Articolo in formato PDF

Anteprima articolo

FrancoAngeli è membro della Publishers International Linking Association, Inc (PILA)associazione indipendente e non profit per facilitare (attraverso i servizi tecnologici implementati da CrossRef.org) l’accesso degli studiosi ai contenuti digitali nelle pubblicazioni professionali e scientifiche

This article presents five key concepts for understanding, assessing and treating dissociation and dissociative disorders. The concepts are: (1) dissociation is a multifaceted construct; (2) dissociation is related to traumatic experiences; (3) the domains of dissociation involve almost the entire spectrum of psychopathology; (4) the commonly used measures for the assessment of dissociation are valid and reliable; (5) dissociative identity disorder exists and is the result of severe relational trauma in childhood. These concepts offer a unitary and comprehensive knowledge that can guide novel or expert clinicians in recognizing, assessing and addressing problems in people who manifest excessively activated dissociative processes.

Questo articolo presenta cinque concetti centrali per la comprensione, la diagnosi e il trattamento della dissociazione e dei disturbi dissociativi. Tali concetti sono: (1) la dissociazione è un costrutto multidimensionale; (2) la dissociazione è connessa alle esperienze traumatiche; (3) i domini della dissociazione si manifestano in un ampio spettro di psicopatologie; (4) gli strumenti di misurazione più comunemente usati per la valutazione della dissociazione sono validi e attendibili; (5) il disturbo dissociativo dell’identità esiste, ed è il risultato di gravi traumi relazionali nell’infanzia. Questi cinque concetti rappresentano una conoscenza unitaria che dovrebbe guidare i clinici, a prescindere dal loro grado di esperienza, nel riconoscimento, nella valutazione e nel trattamento degli individui che presentano processi dissociativi particolarmente attivi.

Keywords:Dissociazione, disturbi dissociativi, trauma complesso, valutazione, diagnosi

  1. American Psychiatric Association. DSM-5. Diagnostic and statistical manual of mental disorders (5th ed). Arlington: American Psychiatric Association; 2013.
  2. Cardeña E. The domain of dissociation. In: Lynn SJ, Rhue JW, eds. Dissociation: clinical and theoretical perspectives. New York: Guilford Press; 1994. p. 15-31.
  3. Schimmenti A, Caretti V. Linking the overwhelming with the unbearable: developmental trauma, dissociation, and the disconnected self. Psychoanalytic Psychology 2016; 33(1):106-28,
  4. World Health Organization. The ICD-10 classification of mental and behavioural disorders: clinical descriptions and diagnostic guidelines (Vol. 1). Geneva: World Health Organization; 1992.
  5. Van der Hart O, Nijenhuis ER, Steele K, ed. The haunted self: Structural dissociation and the treatment of chronic traumatization. New York and London: WW Norton & Company; 2006.
  6. Janet P. The mental state of hystericals: a study of mental stigmata and mental accidents. New York and London: GP Putnam’s sons; 1901.
  7. Spiegel D, Cardeña E. Disintegrated experience: the dissociative disorders revisited. Journal of abnormal psychology 1991; 100(3):366-78, DOI: 10.1037/0021-843X.100.3.366
  8. Dalenberg CJ, Brand BL, Gleaves DH, Dorahy MJ, Loewenstein RJ, Cardena E, et al. (2012). Evaluation of the evidence for the trauma and fantasy models of dissociation. Psychological bulletin 2012; 138(3):550-88,
  9. Schimmenti A. The trauma factor: examining the relationships among different types of trauma, dissociation, and psychopathology. Journal of Trauma & Dissociation 2017; 1-20, DOI: 10.1080/15299732.2017.1402400
  10. Zoroglu SS, Tuzun U, Sar V, Tutkun H, Savaçs HA, Ozturk M, et al. Suicide attempt and self-mutilation among Turkish high school students in relation with abuse, neglect and dissociation. Psychiatry and Clinical Neurosciences 2003; 57(1):119-26,
  11. Chu JA, Dill DL. Dissociative symptoms in relation to childhood physical and sexual abuse. The American Journal of Psychiatry 1990; 147(7):887-92,
  12. Schalinski I, Teicher MH. Type and timing of childhood maltreatment and severity of shutdown dissociation in patients with schizophrenia spectrum disorder. PloS one 2015; 10(5), e0127151,
  13. Ogawa JR, Sroufe LA, Weinfield NS, Carlson EA, Egeland B. Development and the fragmented self: Longitudinal study of dissociative symptomatology in a nonclinical sample. Development and Psychopathology 1997; 9(4), 855-79, DOI: 10.1017/S0954579497001478
  14. Dutra L, Bureau J, Holmes B, Lyubchik A, Lyons-Ruth K. Quality of early care and childhood trauma: A prospective study of developmental pathways to dissociation. Journal of Nervous and Mental Disease 2009; 197(6):383-90.
  15. Porges S, Dana D, ed. Clinical applications of the polyvagal theory: the emergence of polyvagal informed therapies. New York: WW Norton & Company, Inc; 2018.
  16. Schore AN. Affect dysregulation and disorders of the self. New York and London: WW Norton & Company; 2003.
  17. Schimmenti A. Dissociative experiences and dissociative minds: exploring a nomological network of dissociative functioning. Journal of Trauma & Dissociation 2016; 17(3):338-361, DOI: 10.1080/15299732.2015.1108948
  18. Schimmenti A. The developmental roots of dissociation: a multiple mediation analysis. Psychoanalytic Psychology 2017; 34(1):96-105,
  19. Allen JG. Mentalization in the development and treatment of attachment trauma. London: Karnac Books; 2013.
  20. van der Kolk BA, McFarlane AC, Weisaeth L, ed. Traumatic stress: the effects of overwhelming experience on mind, body, and society. New York: Guilford Press; 1996.
  21. Cardeña E, Carlson EB. Acute stress disorder revisited. Annual Review of Clinical Psychology 2011; 7:245-67,
  22. Putnam FW, Carlson EB, Ross CA, Anderson G, Clark P, Torem M, et al. Patterns of dissociation in clinical and nonclinical samples. The Journal of Nervous and Mental Disease 1996; 184(11): 673-9, DOI: 10.1097/00005053-199611000-00004
  23. Lyssenko L, Schmahl C, Bockhacker L, Vonderlin R, Bohus M, Kleindienst M. (2017). Dissociation in psychiatric disorders: a meta-analysis of studies using the dissociative experiences scale. American Journal of Psychiatry, 2018; 175(1):37-46,
  24. Zlotnick C, Zakriski AL, Shea MT, Costello E, Begin A, Pearlstein T, et al. The long-term sequelae of sexual abuse: Support for a complex posttraumatic stress disorder. Journal of traumatic stress 1996; 9(2):195-205,
  25. Carlson EB, Putnam FW. Development, reliability and validity of a dissociation scale. Journal of Nervous and Mental Disease 1986; 174(12):727-35, DOI: 10.1097/00005053198612000-00004
  26. Carlson EB, Putnam FW. An update on the dissociative experiences scale. Dissociation: progress in the dissociative disorders 1993; 6(1):16-27.
  27. Carlson EB, Putnam FW, Ross CA, Torem M, Coons P, Dill DL, Braun, BG. Validity of the Dissociative Experiences Scale in screening for multiple personality disorder: a multicenter study. American Journal of Psychiatry 1993; 150(7):1030-36,
  28. Van IJzendoorn MH, Schuengel C. The measurement of dissociation in normal and clinical populations: meta-analytic validation of the dissociative experiences scale (DES). Clinical Psychology Review 1996; 16(5):365-82, DOI: 10.1016/0272-7358(96)00006-2
  29. Waller NG, Putnam FW, Carlson EB. Types of dissociation and dissociative types: a taxometric analysis of dissociative experiences. Psychological Methods 1996; 1(3):300-21. DOI: 10.1037/1082-989X.1.3.300
  30. Armstrong JG, Putnam FW, Carlson EB, Libero DZ, Smith SR. Development and validation of a measure of adolescent dissociation: the adolescent dissociative experiences scale. Journal of Nervous and Mental Disease 1997; 185:491-97. DOI: 10.1097/00005053199708000-00003
  31. Schimmenti A. Psychometric properties of the adolescent dissociative experiences scale in a sample of Italian adolescents. Journal of Trauma & Dissociation 2016; 17(2):244-57, DOI: 10.1080/15299732.2015.1064507
  32. Putnam FW, Helmers K, Trickett PK. Development, reliability, and validity of a child dissociation scale. Child Abuse & Neglect 1993; 17(6):731-41, DOI: 10.1016/S01452134(08)80004-X
  33. Brand BL, Classen CC, McNary SW, Zaveri P. A review of dissociative disorders treatment studies. The Journal of Nervous and Mental Disease 2009; 197(9):646-54,
  34. Brand BL, Loewenstein RJ, Spiegel D. Dispelling myths about dissociative identity disorder treatment: An empirically based approach. Psychiatry: Interpersonal and Biological Processes 2014; 77(2):169-89,
  35. Nijenhuis ERS, Spinhoven P, Van Dyck R, Van der Hart O, Vanderlinden J. The development and the psychometric characteristics of the Somatoform Dissociation Questionnaire (SDQ-20). Journal of Nervous and Mental Disease 1996; 184(11):688-94, DOI: 10.1097/00005053-199611000-00006
  36. Nijenhuis ERS (2001). Somatoform dissociation: major symptoms of dissociative disorders. Journal of Trauma & Dissociation 2001; 1(4):7-32,
  37. Nijenhuis ERS, Van Dyck R, Spinhoven P, van der Hart O, Chatrou M, Vanderlinden J, et al. Somatoform dissociation discriminates among diagnostic categories over and above general psychopathology. Australian & New Zealand Journal of Psychiatry 1999; 33(4):511-20,
  38. Nijenhuis ERS. Somatoform dissociation: phenomena, measurement and theoretical issues. Italian edition: Caretti V, Schimmenti A, ed. Roma: Astrolabio; 2007.
  39. Dell PF. The multidimensional inventory of dissociation (MID): a comprehensive measure of pathological dissociation. Journal of Trauma & Dissociation 2006; 7(2):77-106,
  40. Ross CA, Heber S, Norton GR, Anderson G, Anderson D, Barchet P. The dissociative disorders interview schedule: a structured interview. Dissociation 1989; 2(3):169-89,
  41. Ross CA, Heber S, Anderson G. The dissociative disorders interview schedule. The American Journal of Psychiatry 1990; 147(12):1698-9,
  42. Ross CA, Browning E. The self-report dissociative disorders interview schedule: a preliminary report. Journal of Trauma & Dissociation 2017; 18(1):31-7, DOI: 10.1080/15299732.2016.1172538
  43. Steinberg M. Structured Clinical Interview for DSM-IV Dissociative Disorders (SCID-D), Revised. Washington: American Psychiatric Press; 1994.
  44. Steinberg M. Advances in the clinical assessment of dissociation: the SCIDDR. Bulletin of the Menninger Clinic 2000; 64(2):146-63.
  45. Dorahy MJ, Brand BL, Şar V, Krüger C, Stavropoulos P, Martínez-Taboas A, et al. Dissociative identity disorder: an empirical overview. Australian & New Zealand Journal of Psychiatry 2014; 48(5):402-17, DOI: 10.1177/0004867414527523
  46. Kluft RP, editor. Childhood antecedents of multiple personality disorder. Washington: American Psychiatric Press; 1985.
  47. Brand BL, Sar V, Stavropoulos P, Krüger C, Korzekwa M, Martínez-Taboas A, et al. Separating fact from fiction: an empirical examination of six myths about dissociative identity disorder. Harvard Review of Psychiatry 2016; 24(4):257-70, DOI: 10.1097/HRP.0000000000000100
  48. Morselli GE. Sulla dissociazione mentale [On mental dissociation]. Rivista sperimentale di Freniatria 1930; 53(2): 209-322.
  49. Ellenberger HF. The discovery of the unconscious: the history and evaluation of dynamic psychiatry. New York: Basic Books; 1970.
  50. Schimmenti A. Elena: A case of dissociative identity disorder from the 1920s. Bulletin of the Menninger Clinic 2017; 81(3):281-98,
  51. Leonard D, Brann S, Tiller J. Dissociative disorders: pathways to diagnosis, clinician attitudes and their impact. Australian and New Zealand journal of psychiatry 2005; 39(10):940-6,
  52. Modestin J, Ebner G, Junghan M, Erni T. Dissociative experiences and dissociative disorders in acute psychiatric inpatients. Comprehensive Psychiatry 1996; 37(5):355-61, DOI: 10.1016/S0010-440X(96)90017-6
  53. Foote B, Smolin Y, Kaplan M, Legatt ME, Lipschitz D. Prevalence of dissociative disorders in psychiatric outpatients. American Journal of Psychiatry 2006; 163(4):623-9,
  54. Şar V, Akyüz G, Doğan O. Prevalence of dissociative disorders among women in the general population. Psychiatry Research 2007; 149(1): 169-76,
  55. Lynn SJ, Lilienfeld SO, Merckelbach H, Giesbrecht T, McNally RJ, Loftus EF, et al. The trauma model of dissociation: inconvenient truths and stubborn fictions. Comment on Dalenberg et al. (2012). Psychological Bulletin 2014; 140(3):896-910,
  56. Boon S, Draijer N. Multiple personality disorder in The Netherlands: a clinical investigation of 71 patients. The American Journal of Psychiatry 1993; 150(3):489-94,
  57. Brand BL, Armstrong JG, Loewenstein RJ, McNary SW. Personality differences on the Rorschach of dissociative identity disorder, borderline personality disorder, and psychotic inpatients. Psychological Trauma: Theory, Research, Practice, and Policy 2009; 1(3):188- 205,
  58. Brand BL, Chasson GS. Distinguishing simulated from genuine dissociative identity disorder on the MMPI-2. Psychological Trauma: Theory, Research, Practice, and Policy 2015; 7(1):93-101,
  59. Brand BL, Loewenstein RJ. Dissociative disorders: an overview of assessment, phenomenology and treatment. Psychiatric Times 2010; 27:62-9.
  60. International society for the study of trauma and dissociation (ISSTD). Guidelines for treating dissociative identity disorder in adults, third revision. Journal of Trauma & Dissociation 2011; 12(2):115-87, DOI: 10.1080/15299732.2011.537247
  61. Brand BL, McNary SW, Myrick AC, Classen CC, Lanius R, Loewenstein RJ, et al. A longitudinal naturalistic study of patients with dissociative disorders treated by community clinicians. Psychological Trauma: Theory, Research, Practice, and Policy 2013; 5(4):301-8,
  62. Myrick AC, Brand BL, McNary SW, Classen CC, Lanius R, Loewenstein RJ, et al. An exploration of young adults’ progress in treatment for dissociative disorder. Journal of Trauma & Dissociation: the Official Journal of the International Society for the Study of Dissociation (ISSD) 2012; 13(5):582-95, DOI: 10.1080/15299732.2012.694841
  63. Myrick AC, Webermann AR, Loewenstein RJ, Lanius R, Putnam FW, Brand BL. Six-year follow up of the treatment of patients with dissociative disorders study. European Journal of Psychotraumatology 2017; 8(1):1344080, DOI: 10.1080/20008198.2017.1344080
  64. Kluft RP. Treatment of multiple personality disorder. A study of 33 cases. Psychiatric Clinics of North America 1984; 7:9-29.
  65. Myrick AC, Webermann AR, Langeland W, Putnam FW, Brand BL. Treatment of dissociative disorders and reported changes in inpatient and outpatient cost estimates. European Journal of Psychotraumatology 2017; 8(1) 1375829, DOI: 10.1080/20008198.2017.1375829
  66. Şar V, Dorahy MJ, Krüger C. Revisiting the etiological aspects of dissociative identity disorder: a biopsychosocial perspective. Psychology research and behavior management 2017; 10:137-46,
  67. Krüger C, Fletcher L. Predicting a dissociative disorder from type of childhood mal treatment and abuser–abused relational tie. Journal of Trauma & Dissociation 2017; 18(3):356-72, DOI: 10.1080/15299732.2017.1295420
  68. Coons PM. Confirmation of childhood abuse in child and adolescent cases of multiple personality disorder and dissociative disorder not otherwise specified. Journal of Nervous and Mental Disease 1994; 182(8):461-4, DOI: 10.1097/00005053-199408000-00007
  69. Lewis DO, Yeager CA, Swica Y, Pincus JH, Lewis M. Objective documentation of child abuse and dissociation in 12 murderers with dissociative identity disorder. American Journal of Psychiatry 1997; 154(12):1703-10,
  70. Main M, Hesse E. Parents’ unresolved traumatic experiences are related to infant disorganized attachment status: Is frightened and/or frightening parental behavior the linking mechanism? Attachment in the preschool years: Theory, research and intervention. In: Greenberg M, Cicchetti D, Cummings EM, ed. Chicago: University of Chicago Press; 1990. p. 161-84.
  71. Bowlby J. Attachment and loss: Vol. 2. Separation anxiety and anger. London: Hogarth Press; 1973.
  72. Reisz S, Duschinsky R, Siegel DJ. Disorganized attachment and defense: exploring John Bowlby’s unpublished reflections. Attachment & Human Development 2018; 20(2):107-34, DOI: 10.1080/14616734.20171-28
  73. Fagan J, McMahon PP. Incipient multiple personality in children: four cases. Journal of Nervous and Mental Disease 1984; 172(1):26-36, DOI: 10.1097/00005053-19840100000007
  74. Laporta LD. Childhood trauma and multiple personality disorder: the case of a 9-year-old girl. Child Abuse and Neglect 1992; 16(4):615-20, DOI: 10.1016/0145-2134(92)90076-4

Adriano Schimmenti, Five lessons on dissociation in "RIVISTA SPERIMENTALE DI FRENIATRIA" 1/2018, pp 73-91, DOI: 10.3280/RSF2018-001005