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.

Although information about individuals' exposure to highly stressful events such as traumatic stressors is often very useful for clinicians and researchers, available measures are too long and complex for use in many settings. The Trauma History Screen was developed to provide a very brief and easy-to-complete self-report measure of exposure to high magnitude stressor (HMS) events and of events associated with significant and persisting posttraumatic distress (PPD). The measure assesses the frequency of HMS and PPD events, and it provides detailed information about PPD events. Test-retest reliability was studied in four samples, and temporal stability was good to excellent for items and trauma types and excellent for overall HMS and PPD scores. Comprehensibility of items was supported by expert ratings of how well items appeared to be understood by participants with relatively low reading levels. In five samples, construct validity was supported by findings of strong convergent validity with a longer measure of trauma exposure and by correlations of HMS and PPD scores with PTSD symptoms. The psychometric properties Correspondence concerning this article should be addressed to Eve Carlson, Ph.D., National Center for PTSD (334-PTSD), 795 Willow Rd., Menlo Park, CA 94025. eve.carlson@va.gov. Publisher's Disclaimer: The following manuscript is the final accepted manuscript. It has not been subjected to the final copyediting, fact-checking, and proofreading required for formal publication. It is not the definitive, publisher-authenticated version. The American Psychological Association and its Council of Editors disclaim any responsibility or liabilities for errors or omissions of this manuscript version, any version derived from this manuscript by NIH, or other third parties. The published version is available at www.apa.org/pubs/journals/pas NIH Public Access Exposure to sudden, highly stressful events is fairly common among the general population in the U.S. (Breslau, 2002) and is even more frequent among those seeking mental health treatment (Jacobson, 1989). Information about exposure to sudden, severe stressors is clinically important because such exposure has been found to be associated with increases in later psychological disorder (Brown, Fulton, Wilkeson, & Petty, 2000;Bryant et al., 2010) and decreases in physical health (Schnurr & Green, 2004), occupational functioning (Zatzick et al., 2008), and socioeconomic well-being (Zielinski, 2009). In prospective studies and meta-analyses of trauma research, psychological disorders found to increase most following highly stressful events include depression, generalized anxiety disorder, posttraumatic stress disorder (PTSD), agoraphobia, phobia, and substance abuse (Brown et al., 2000;Bryant et al., 2010;Reed, Anthony, & Breslau, 2007). In addition, repeated, severe sudden stressors that occur during early childhood are thought to play a role in the development of borderline personality disorder (Herman & van der Kolk, 1987); some dissociative disorders (De...

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Since Janet wrote about dissociation in the early 1900s, the relationship between traumatic stress and dissociation has been discussed and debated in the fields of psychology and psychiatry. In the last 25 years, research has been conducted that allows empirical examination of this relationship and the question of how dissociative symptoms are related to posttraumatic stress disorder (PTSD). After defining the types of dissociative experiences that are considered most relevant to PTSD, we present a comprehensive and systematic review of research addressing the relationship between dissociation and traumatic stress; the rise in dissociation after traumatic stress and its subsequent decline over time; the relationship between dissociation and symptoms of PTSD in nonclinical, clinical, and PTSD samples; the conditional probability of high PTSD symptoms when dissociation level is high; the relationships among dissociation and re-experiencing, avoidance, and hyperarousal symptoms of PTSD; and biological studies of disso ciation in PTSD.

U nderstanding strong countertransference reactions can be the hardest part of practice for many mental health professionalsparticularly with patients who have experienced great trauma. This new book from APA's most popular book series is here to help. In a concise and practical format, this book shows mental health practitioners how they can manage their countertransference reactions and use them as a force for healing in patients suffering from trauma.

Planning, problem solving, and inhibitory abilities are significantly affected by alcohol abuse, with decisional and cognitive forms of impulsivity most impacted. Cognitive remediation targeting these deficits might increase the related functions that mediate the ability to moderate or abstain from alcohol, and so lead to improved treatment results.

Seventeen patients who had recovered memories of abuse in therapy participated in a search for evidence confirming or refuting these memories. Memories of abuse were found to be equally accurate whether recovered or continuously remembered. Predictors of number of memory units for which evidence was uncovered included several measures of memory and perceptual accuracy. Recovered memories that were later supported arose in psychotherapy more typically during periods of positive rather than negative feeling toward the therapist, and they were more likely to be held with confidence by the abuse victim.

The purpose of this article is to examine how closely six theoretical models fit the empirical evidence reviewed in Part 1 on the relationship between trauma and dissociation and to apply the resulting conclusions to make recommendations about diagnostic criteria for PTSD. We describe six models for the relationships among traumatic stress, dissociation, and PTSD, including models for fantasyproneness, mediation, comorbidity, interactional comorbidity, component, and subtype. The research reviewed strongly supports component and subtype models of the relationship between dissociation and PTSD, and recommendations are made for including dissociative symptoms in the diagnostic criteria for PTSD in ICD-11 and DSM-5 and adding either a dissociative subtype or a complex PTSD diagnosis in both diagnostic systems.