In this article, the authors present evidence regarding a dissociative subtype of PTSD, with clinical and neurobiological features that can be distinguished from nondissociative PTSD. The dissociative subtype is characterized by overmodulation of affect, while the more common undermodulated type involves the predominance of reexperiencing and hyperarousal symptoms. This article focuses on the neural manifestations of the dissociative subtype in PTSD and compares it to those underlying the reexperiencing/hyperaroused subtype. A model that includes these two types of emotion dysregulation in PTSD is described. In this model, reexperiencing/hyperarousal reactivity is viewed as a form of emotion dysregulation that involves emotional undermodulation, mediated by failure of prefrontal inhibition of limbic regions. In contrast, the dissociative subtype of PTSD is described as a form of emotion dysregulation that involves emotional overmodulation mediated by midline prefrontal inhibition of the same limbic regions. Both types of modulation are involved in a dynamic interplay and lead to alternating symptom profiles in PTSD. These findings have important implications for treatment of PTSD, including the need to assess patients with PTSD for dissociative symptoms and to incorporate the treatment of dissociative symptoms into stage-oriented trauma treatment.

The relationship between a reported history of trauma and dissociative symptoms has been explained in 2 conflicting ways. Pathological dissociation has been conceptualized as a response to antecedent traumatic stress and/or severe psychological adversity. Others have proposed that dissociation makes individuals prone to fantasy, thereby engendering confabulated memories of trauma. We examine data related to a series of 8 contrasting predictions based on the trauma model and the fantasy model of dissociation. In keeping with the trauma model, the relationship between trauma and dissociation was consistent and moderate in strength, and remained significant when objective measures of trauma were used. Dissociation was temporally related to trauma and trauma treatment, and was predictive of trauma history when fantasy proneness was controlled. Dissociation was not reliably associated with suggestibility, nor was there evidence for the fantasy model prediction of greater inaccuracy of recovered memory. Instead, dissociation was positively related to a history of trauma memory recovery and negatively related to the more general measures of narrative cohesion. Research also supports the trauma theory of dissociation as a regulatory response to fear or other extreme emotion with measurable biological correlates. We conclude, on the basis of evidence related to these 8 predictions, that there is strong empirical support for the hypothesis that trauma causes dissociation, and that dissociation remains related to trauma history when fantasy proneness is controlled. We find little support for the hypothesis that the dissociation-trauma relationship is due to fantasy proneness or confabulated memories of trauma.

We recommend that consideration be given to adding a dissociative subtype of PTSD in the revision of the DSM. This facilitates more accurate analysis of different phenotypes of PTSD, assist in treatment planning that is informed by considering the degree of patients' dissociativity, will improve treatment outcome, and will lead to much-needed research about the prevalence, symptomatology, neurobiology, and treatment of individuals with the dissociative subtype of PTSD.

The goals of this naturalistic, cross-sectional study were to describe the patient, therapist, and therapeutic conditions of an international sample of dissociative disorder (DD) patients treated by community therapists and to determine if community treatment for DD appears to be as effective as treatment for chronic PTSD and conditions comorbid with DD. Analyses found that across both patient (N ϭ 280) and therapist (N ϭ 292) reports, patients in the later stages of treatment engaged in fewer self-injurious behaviors, had fewer hospitalizations, and showed higher levels of various measures of adaptive functioning (e.g., GAF) than those in the initial stage of treatment. Additionally, patients in the later stages of treatment reported lower symptoms of dissociation, posttraumatic stress disorder, and distress than patients in the initial stage of treatment. The effect sizes for Stage 5 versus Stage 1 differences in DD treatment were comparable to those published for chronic PTSD associated with childhood trauma and depression comorbid with borderline personality disorder. Given the prevalence, severity, chronicity, and high health care costs associated with DD, these results suggest that extended treatment for DD may be beneficial and merits further research.

Secure parental attachment and healthy levels of separation-individuation have been consistently linked to greater college student adjustment. The present study proposes that the relation between parental attachment and college adjustment is mediated by healthy separation-individuation. The authors gathered data on maternal and paternal attachment, separation-individuation, and 3 dimensions of college adjustment in a sample of 404 college students. Using structural equation modeling, results supported a model in which separation-individuation fully mediated the link between attachment and college adjustment, for both men and women. Implications of these results are discussed for individuation-within-relatedness models of adolescent development and for counseling college students in distress.

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. Method: The overview is limited to DID-specific research in which one or more of the following conditions are met: 1) a sample of participants with DID was systematically investigated, 2) psychometrically-sound measures were utilised, 3) comparisons were made with other samples, 4) DID was differentiated from other DID: An empirical overview 2 disorders, including other Dissociative Disorders, 5) extraneous variables were controlled or 6) DID diagnosis was confirmed. Following an examination of challenges to research, data is 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. KeywordsDissociative identity disorder, validity, phenomenology, aetiology, psychobiology, [see Taylor, 1983 ], Janet, 1907Prince, 1905). More recently DID has become the subject of considerable debate (e.g., Dalenberg et al., 2012;Gleaves, 1996;McHugh and Putnam, 1995;Merskey, 1992), especially around its validity, aetiology and prevalence. Often This overview is designed to provide a current "broad-brush" outline of the scientific foundation of DID by focusing on DID-specific research. Thus the overview excludes opinion pieces and papers without DID data and is confined to studies identified in searches of major psychological (e.g., Psycinfo) and psychiatric databases (e.g., Medline) which investigated individuals with DID where one or more of the following conditions were met: 1) a sample of participants with DID was systematically investigated, 2) psychometrically-sound measures were utilised, 3) comparisons were made with other samples, 4) DID was differentiat...

This study examined effects of a peer-led social support group intervention on college adjustment. Ninety first-year students, randomly assigned to participate in the intervention, reported higher levels of perceived social support and reduced loneliness when compared to controls (n = 94), after accounting for preintervention levels on these variables. Effects were not moderated by precollege adjustment concerns or gender. Results of this study suggest that a cost-effective peer-led intervention program can positively affect students’ social adjustment to university at a large, 4-year institution.

Severe dissociative disorders (DD) are associated with high levels of impairment, treatment utilization, and treatment costs, yet relatively little systematic research has focused on treatment for these challenging patients. The goal of this naturalistic observational 30-month follow-up study of an international sample of patients with dissociative disorders was to determine if treatment provided by community providers was associated with improvements in symptoms and adaptive functioning. The patients were diagnosed with dissociative identity disorder (DID) and dissociative disorder not otherwise specified (DDNOS). The patients and their therapists completed surveys at study entry and at 6-, 18-, and 30-month follow-up. At the 30-month follow-up, 119 of the original 226 patients completed the surveys. According to patients' reports, they showed decreased levels of dissociation, posttraumatic stress disorder symptoms, general distress, drug use, physical pain, and depression over the course of treatment. As treatment progressed, patients reported increased socializing, attending school or volunteering, and feeling good. According to therapists' reports, patients engaged in less self-injurious behavior and had fewer hospitalizations as well as increased global assessment of functioning scores (American Psychiatric Association, 2000) and adaptive capacities over time. These results suggest that treatment provided by therapists who have training in treating DID/DDNOS appears to be beneficial across a number of clinical domains. Additional research into the treatment of DD is warranted.