Evaluation of the evidence for the trauma and fantasy models of dissociation.

Abstract

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.

The trauma model of dissociation: Inconvenient truths and stubborn fictions. Comment on Dalenberg et al. (2012).

“…1 An early alternative to the TM, the sociocognitive model (SCM; Lilienfeld et al, 1999;Spanos, 1996), proposed that symptoms of dissociative identity disorder (DID) and perhaps related dissociative disorders result when people with coexisting or ambiguous psychological symptoms are exposed to suggestive procedures (e.g., repeated questioning about memories and personality "parts," leading questions, hypnosis, journaling; see Lynn, Krackow, Loftus, & Lilienfeld, in press), media influences (e.g., film and television), and broader sociocultural expectations (e.g., "dissociation is associated with abuse," people possess "multiple personalities") regarding the presumed clinical features of DID. The sociocognitive perspective considers implausible the classical trauma-dissociation hypothesis that people actually house multiple "personalities" (i.e., alters) or poorly defined "personality states"-which are somehow walled off or dissociated from everyday consciousness-to defend against thoughts and feelings stemming from traumatic experiences.As Dalenberg et al (2012) observed, people with DID often report histories of childhood trauma. Although ethical considerations preclude directly testing the hypothesis that false memories of abuse can be elicited by suggestive methods, researchers have shown that it is possible to implant memories of false or highly implausible events, including being (a) in a crib in childhood and viewing a mobile over the bed, (b) bullied, (c) witness to a demonic possession, (d) the victim of a vicious animal attack, and (d) a rider in a hot air balloon (see Lynn et al, in press, for a review).…”

“…As Dalenberg et al (2012) observed, people with DID often report histories of childhood trauma. Although ethical considerations preclude directly testing the hypothesis that false memories of abuse can be elicited by suggestive methods, researchers have shown that it is possible to implant memories of false or highly implausible events, including being (a) in a crib in childhood and viewing a mobile over the bed, (b) bullied, (c) witness to a demonic possession, (d) the victim of a vicious animal attack, and (d) a rider in a hot air balloon (see Lynn et al, in press, for a review).…”

“…Notably, the FM does not distinguish between dissociative experiences arising from fantasy versus trauma, and variables associated with the FM explain the antecedents and correlates of both trait and state dissociation (e.g., Candel & Merckelbach, 2004; Kunst, Winkel, & Bogaerts, 2011). 3 In their review, Dalenberg et al (2012) defend the TM and criticize the FM. We agree with several of their arguments.…”

“…In our reply, we examine Dalenberg et al's key arguments in light of the eight predictions they believe afford clear tests of the TM and the FM. Dalenberg et al (2012) stated that "the TM predicts a consistent positive relationship across studies between trauma and dissociation" (p. 553), whereas proponents of the FM "argue that dissociation is a psychological process causally unrelated to antecedent traumatic or stressful events" (p. 551; emphasis added). Dalenberg et al's (2012) characterization of the FM is incomplete and does not reflect our current position.…”

Trauma-related altered states of consciousness in post-traumatic stress disorder patients with or without comorbid dissociative disorders

“…Furthermore, higher reporting of childhood emotional neglect emerged as the only significant difference between patients with and without CDD comorbidity. Although physical abuse and sexual abuse are mostly hypothesized as etiological factors in the development of CDD (Brand & Frewen, 2017; Dalenberg et al, 2012), this may point to a role of experiences of emotional neglect in the development of CDD comorbidity. For example, DePrince, Huntjens, and Dorahy (2015) found alienating appraisals (i.e.…”