Pathological Dissociation Research Articles

Dissociation in Long-Term Care Home Staff During COVID-19: Challenges and Promising Practices

ObjectivesLong-term care (LTC) staff may develop dissociation due to high-stress work environments and trauma exposures. This study aimed to (1) assess the prevalence of pathological dissociation in LTC home staff during the COVID-19 pandemic; (2) examine the associations of pathological dissociation with demographic characteristics, mental health, insomnia, and professional quality of life; and (3) examine whether pathological dissociation was sensitive to change following a coherent breathing intervention. DesignWe analyzed data from a pre-post breathing intervention study conducted between January and September 2022. Settings and ParticipantsParticipants were 254 staff (care aides, nurses, and managers) from 31 LTC homes in Alberta, Canada. MethodsWe measured pathological dissociation using the Dissociative Experiences Scale-Taxon (DES-T). We conducted χ2 test and t tests to examine the association of pathological dissociation with other variables pre-intervention. We used a 2-level random intercept logistic regression analysis to examine the change in pathological dissociation from pre- to post-intervention. ResultsAbout 12% and 8% of the sample experienced pathological dissociation pre- and post-intervention, respectively. Pathological dissociation was significantly associated with stress, psychological distress, anxiety, depression, posttraumatic stress disorder, and insomnia (P < .05); it was also significantly associated with language, race, and professional role (P < .05). Participants had lower odds of experiencing pathological dissociation post-intervention compared with pre-intervention (odds ratio, 0.41; P = .045). Conclusions and ImplicationsLTC home staff exhibited a high prevalence of pathological dissociation during COVID-19, significantly linked to other mental health measures. A coherent breathing intervention showed potential in reducing reports of dissociation. Further research is needed to understand dissociation in LTC staff and its interplay with mental health outcomes, sleep quality, and personal/work-related factors. Understanding the work environment's role and assessing interventions targeting working conditions could mitigate dissociation and promote a trauma-informed workplace. Rigorous study designs are needed to generate stronger evidence for nonpharmacological interventions like coherent breathing.

Childhood trauma and dissociative symptoms among young adults: A longitudinal study of the role of self-stigma

Dissociative symptoms, which are psychiatric phenomena recognized in both ICD-11 and DSM-5-TR, refer to failures in the process of integrating one's biopsychosocial experiences. While research shows that childhood trauma is associated with dissociative symptoms, little is known about whether childhood trauma could predict increases in dissociative symptoms even within a short period of time. Additionally, it remains unclear what moderators may influence this relationship. This study examined the effects of childhood trauma on subsequent dissociative symptoms and explored the potential moderating effects of mental health-related self-stigma. We analyzed longitudinal survey data from an international sample of young adults (N = 146). Participants completed validated standardized measures of childhood trauma, self-stigma, and dissociative symptoms at baseline, and they reported their dissociative symptoms again after approximately three months. Over 75 % of participants with pathological dissociation at baseline continued to exhibit pathological dissociation at follow-up. Baseline childhood trauma was associated with increases in dissociative symptoms even within a short period of time. Self-stigma significantly moderated the relationship between baseline childhood trauma and subsequent dissociative symptoms, after controlling for baseline dissociative symptoms. This study confirmed that childhood trauma is associated with increases in dissociative symptoms even within three months. We also found that self-stigma may exacerbate the effects of childhood trauma on subsequent dissociative symptoms. The results provide insights into the prevention and management of dissociative symptoms in childhood trauma survivors and inform the modification of the trauma model of dissociation.

Psychoanalysis of the unspectacular.

From the perspective of a poet and first-year psychoanalytic training candidate, this paper develops Jeremy Safran's ideas about the dialectic between psychoanalysis and Buddhism by drawing an analogy between their processes and those of a poetry practice to define an alternative to pathological dissociation under capitalist systems of value. The paper details the writer's experience of working a day job in an office and the pathological dissociation which she subsequently attempts to overcome and critique through writing poetry. Various poems written at work are shared and analyzed as evidence. Drawing from Safran's edited volume, Psychoanalysis and Buddhism, the author then identifies aspects of Zen Buddhist meditation practice and the psychoanalytic process that focus on connecting with reality, however conflicted, as opposed to escaping it. This paper was written under the mentorship of the psychoanalyst and Zen teacher Barry Magid.

Dissociation and the insanity defense: A review of U.S. Federal appellate case law.

Pathological dissociation is relatively common in the United States and may be associated with violent or criminal behavior. Dissociative Disorders, especially Dissociative Identity Disorder, are considered controversial diagnoses by some in the psychiatric and legal professions. Individuals who offend during dissociative states may not be criminally responsible if they meet the legal standard for insanity, however, insanity pleas based on dissociative symptoms are rare. This review examined Federal appellate case law for potential legal barriers to the insanity defense for dissociative conditions and any restrictions imposed on related expert evidence. Few rulings directly addressed these questions but there do not appear to be any unique barriers for dissociation-related insanity pleas. Some cases provided valuable insights regarding the admission of expert evidence, effective expert testimony, and the role of defense counsel.

Survival, Attachment, and Healing: An Evolutionary Lens on Interventions for Trauma-Related Dissociation.

Dissociation is a necessary part of our threat response system, common to all animal species, normally temporarily activated under conditions of extreme or inescapable threat. Pathological dissociation, however, continues to occur after the initial threat has passed, in response to reminders or inaccessibility of safety and security. Present across the spectrum of psychiatric diagnoses, recurrent dissociative symptoms are linked to severe trauma exposure, insecure attachment, treatment non-response, and maladaptive coping behaviors such as substance use, suicidality, and self-harm. However, empirical studies testing treatments specific to dissociative processes remain scarce. This narrative review summarizes existing studies and provides theoretical, neurobiological, and evolutionary perspectives on dissociative processes and treatments for pathological dissociation. A systematic search of five databases (MEDLINE, EMBASE, APA PsycINFO, CINAHL plus, Scopus) was conducted on April 13, 2023. Peer-reviewed clinical studies with adult participants, assessing intervention effects on dissociative symptoms, were included. Results were thematically analyzed and summarized. Sixty-nine studies were identified, mainly focused on posttraumatic stress disorder, trauma-exposed populations, and borderline personality disorder. Psychotherapy was studied in 72.5% of studies; other interventions included medications and neurostimulation. The majority reported positive outcomes, despite the heterogeneous spectrum of interventions. However, treatment of dissociative symptoms was the primary objective in only a minority. Pathological dissociation is a complex phenomenon involving brain and body systems designed for perceiving and responding to severe threats, requiring an individualized approach. A literature is emerging regarding potentially evidence-based treatments to help those impacted by recurrent dissociative symptoms. When contextualized within a neurobiological and evolutionary perspective, these treatments can be understood as facilitating an internal and/or relational sense of safety, resulting in symptom reduction. Further studies are needed to explore effective treatments for dissociative symptoms.

Relationship of Behavioral and Cognitive Abilities in Subjects with Pathological Dissociation: An Exploratory Study

Relationship of Behavioral and Cognitive Abilities in Subjects with Pathological Dissociation: An Exploratory Study

Can Emotional or Physical Abuse Be a Risk Factor of Chronic Musculoskeletal Conditions in Professional Dance?

In professional dance, the injury rate is extremely high and dancers have a great chance to experience at least one injury during their careers. Since the #metoo campaign, many abuse cases showed up in the dance industry, resulting in media coverage. Results indicate that dancers had a significantly higher distribution of post-traumatic stress disorder (PTSD) compared to the broad population. In this study, we investigate pathological dissociation, quantify chronic musculoskeletal conditions and evaluate abusive experiences. Questionnaire-based dataset filled out online by Hungarian professional dancers (n = 168). The statistical analysis contains descriptive results, risk assessment, Kaplan Meier curve, and hazard ratios. Dancers scored in the pathological dissociation values, reported several cases of emotional and physical abuse, and were represented by elevated chronic musculoskeletal conditions. We found a statistically significant relationship between abusive experiences and musculoskeletal conditions, so as with dissociation. We conclude that emotional abuse might be one of the factors in a multifactorial model that plays a role in the pathomechanism of chronic pain, inflammation, and tendinopathy. It is important to raise awareness about the importance of emotional factors of pedagogy and the working atmosphere among professional dancers since it might have a role in higher injury rates.

Association between negatively perceived parenting attitudes and dissociation: a cross-sectional study on the general population in Japan.

Many studies have reported that early traumatic experiences, mainly abuse, are associated with forming dangerous attachments and a contributing factor to dissociation. On the other hand, other studies have investigated the association of non-abusive nurturing and attachment styles with dissociation. The aim of this study is to determine the frequency of dissociative experiences in the general Japanese population and investigate the effects of "overprotection" and "lack of care" as nurturing styles and "abandonment anxiety" and "avoidance of intimacy" as attachment styles on dissociation. A total of 1,042 residents aged 18 to 69 years were administered with the Dissociative Experiences Scale (DES), the Japanese version of the WHO-5 Well-Being Index (WHO-5-J), the Parental Bonding Instrument (PBI), and the Experiences in Close Relationships Inventory-the-generalized-other-version (ECR-GO). Hierarchical multiple regression analyses on the effects of "overprotection" and "care" as nurturing attitudes "abandonment anxiety" and "avoidance of intimacy" as attachment styles on dissociation (DES-NDI and DES-T) were conducted. Based on the findings of this study, "care" and "overprotection" as nurturing attitudes were shown to be a contributing factor to dissociation (DES-NDI and DES-T). "Avoidance of intimacy" as an attachment style was shown to contribute to pathological dissociation. On the other hand, the influence of attachment style on the relationship between nurturing style and dissociation was not determined. This study provided essential data on the distribution of dissociative experiences in the general Japanese population. It was indicated that nurturing style, particularly overprotection, may be linked to nonfunctional stress coping and interpersonal anxiety and could be a contributing factor to mental disorders, including dissociation. Furthermore, considering that the effect of nurturing styles on dissociation does not vary with attachment styles, the effect of nurturing styles on dissociation may be more profound.

Development: nurturing and destroying a child

Developmental achievements during the first five years of life are described. From birth children are readily able to engage with and respond to their caregivers, whose attunement is crucial to their welfare. The child learns to differentiate objects and people and develops schemata of relating to others. Spatial exploration and the ability to categorise facilitate the attainment of object and other permanence at around eighteen months of age. At this time children begin to understand that others are intentional agents with internal states that are the sources of attitudes and actions. The child’s identification with others is salient to the formation of identity and the ability to differentiate from others. Play is vital to understanding the nature of symbols. When attachment is secure requisite transitional space is provided and mentalization is achieved. However, a grasp of beliefs and of the difference between appearance and reality is not yet achieved. Attachment characterised by misattunement and/or overt abuse may result in pathological dissociation resulting in developmental deficits that are most extreme in dissociative identity disorder.

The Relationship Between Childhood Trauma, Pathological Dissociation, and Behavioral Addictions in Young Adults: Findings from a Cross-Sectional Study

ABSTRACT Interactions between childhood trauma (CT) and dissociation can contribute to psychiatric disturbances. We explored this phenomenon in relation to behavioral addictions (BAs) in a sample (n = 633) of young adults (age: 18–34 years). Self-report measures investigating CT, dissociation, and symptoms related to gambling disorder, internet gaming disorder, problematic social media use, exercise dependence and compulsive buying were used. Scales related to BAs were summarized into a single measure (“Total Behavioral Addiction Index” – TBAI) for inferential analyses. A model analyzing the direct and indirect effects of CT on TBAI through the mediation of pathological dissociation was performed, controlling for confounding factors. Measures on CT, dissociation, and TBAI were significantly associated with each other (all p < .001). The total effect of CT on TBAI was significant (B = 0.063; CI: 0.045; 0.081); pathological dissociation significantly mediated such association (B = 0.023; CI: 0.013; 0.036). Our findings support the possibility that the interaction between CT and dissociation contributes to increase disturbances related to BAs.

Four reasons why we should screen for dissociation in competitive sports

Four reasons why we should screen for dissociation in competitive sports

Toward a possible trauma subtype of functional neurological disorder: Impact on symptom severity and physical health.

As a group, individuals with functional neurological disorder (FND) report an approximately 3-fold increase in adverse life experiences (ALEs) compared to healthy controls. In patients with FND, studies have identified a positive correlation between symptom severity and the magnitude of ALEs. While not all individuals with FND report ALEs, such findings raise the possibility of a trauma-subtype of FND. This study investigated if patients with FND, with or without probable post-traumatic stress disorder (PTSD) and/or significant childhood maltreatment, differed in their symptom severity and physical health. Seventy-eight patients with FND were recruited (functional seizures, n = 34; functional movement disorder, n = 56). Participants completed self-report measures of symptom severity [Somatoform Dissociation Questionniare-20 (SDQ-20), Screening for Somatoform Disorders: Conversion Disorder subscale (SOMS:CD), Patient Health Questionniare-15 (PHQ-15)], physical health [Short Form Health Survey-36 (SF36-physical health)], childhood maltreatment [Childhood Trauma Questionnaire (CTQ)], and PTSD [PTSD Checklist-5 (PCL-5)]; a psychometric battery of other common predisposing vulnerabilities was also completed. To adjust for multiple comparisons, a Bonferroni correction was applied to all univariate analyses. Patients with FND and probable PTSD (n = 33) vs. those without probable PTSD (n = 43) had statistically significant increased scores on all symptom severity measures - as well as decreased physical health scores. In secondary post-hoc regression analyses, these findings remained significant adjusting for age, sex, race, college education, and: pathological dissociation; alexithymia; attachment styles; personality characteristics; resilience scores; functional seizures subtype; or moderate-to-severe childhood abuse and neglect scores; SOMS:CD and SDQ-20 findings also held adjusting for depression and anxiety scores. In a separate set of analyses, patients with FND and moderate-to-severe childhood abuse (n = 46) vs. those without moderate-to-severe childhood abuse (n = 32) showed statistically significant increased SDQ-20 and PHQ-15 scores; in post-hoc regressions, these findings held adjusting for demographic and other variables. Stratification by childhood neglect did not relate to symptom severity or physical health scores. This study provides support for a possible trauma-subtype of FND. Future research should investigate the neurobiological and treatment relevance of a FND trauma-subtype, as well as continuing to delineate clinical characteristics and mechanisms in individuals with FND that lack a history of ALEs.

Étude de l’agentivité dans le discours de femmes souffrant de trouble de stress post-traumatique dans les suites de violences conjugales

IntroductionIn the absence of appropriate care, psychotraumatic consequences (revival, hyperarousal, avoidance strategies, dissociation and other clinical forms of post traumatic symptoms) can take control of a large part of the subject's existence (psychological, physical, social) and affect the ability of the victim to regain ground on the intrusions that harass, and to take up new life projects. More objective than the current semiological and psychometric approaches, and in the absence of biomarkers that may be used in clinical practice, psycholinguistics opens up an epistemological renewal of the conception of trauma and its clinical consequences, in particular through the definition of the Psycho Linguistic Traumatic Syndrome (SPLIT). If such conceptions have been developed based on the analysis of traumatic accounts of subjects injured in war and attacks, other forms of psychotraumatic confrontations also deserve to be considered. In this paper, our objective was to better characterize the pronominal forms of agency in the traumatic and non-traumatic narratives produced by women victims of domestic and/or sexual violence. MethodsNineteen women aged 20 to 60 victims of domestic violence and diagnosed with post-traumatic stress disorder (Mini International Neuropsychiatric Interview) as well as a matched control group participated in the study. The subjects completed the French versions of Post Traumatic Checklist (PCL-5), Dissociative Experience Scale (DES) and Hospital and Anxiety Depression Scale (HAD). Traumatic and non-traumatic narratives were linguistically coded and scored on the SPLIT-10 scale. ResultsTraumatic narratives contained significantly more first person singular pronouns than the non-traumatic narratives of controls or the non-traumatic narratives of psychically injured people. Traumatic narratives contained significantly more of the direct object pronoun “me” as well as indirect object pronouns. In traumatic narratives, the frequency of use of the subject pronoun “I” tended to correlate negatively with the HAD-A, HAD-D and SPLIT-10, while the frequency of use of the direct object pronoun “me” tended to correlate positively with DES, HAD-A, HAD-D as well as SPLIT-10. Finally, traumatic narratives contained significantly more verbs in the passive voice than non-traumatic narratives. DiscussionThere was a gradient in the use of the first person singular pronoun that was inversely correlated to the degree of traumatic valence of the narratives: the control group used “I” less often than the psychically injured people who appeared to use this pronoun all the more as their narratives had a traumatic valence. In other words, even in the so-called “non-traumatic” narratives produced by subjects suffering from post-traumatic stress disorder, the trauma seemed to be inscribed in the discourse, testimony to dissociation, as the seen in the correlation of this pronominal expression dimension of “I” with the SPLIT-10 scale. The use of the direct object complement was correlated with greater psycho-traumatic morbidity (dissociative, depressive and anxious) than the use of the “I”, the latter remaining however a pathological mark instead of the use of the pronouns “we” or “one”. Saying “I” translated less symptomatology than saying “me”, but it was when the subject said “we” or “one” that he appeared to have returned to a normal discourse, no longer suffering from the torments of reliving or pathological dissociation. The identification of linguistic markers deserves to be pursued in order to better objectively describe post-traumatic psychiatric disorders, to better identify them in clinical practice in the field and to monitor the efficiency of the recommended psychotherapies. More generally, we may put forward the hypothesis that the direct modification of the patient's language, thanks to the intervention of the practitioner, from a speech composed of linguistic markers testifying to the trauma towards a normalized speech could help to treat post-traumatic symptoms.

Deconstructing dissociation: a triple network model of trauma-related dissociation and its subtypes.

Trauma-related pathological dissociation is characterized by disruptions in one's sense of self, perceptual, and affective experience. Dissociation and its trauma-related antecedents disproportionately impact women. However, despite the gender-related prevalence and high individual and societal costs, dissociation remains widely underappreciated in clinical practice. Moreover, dissociation lacks a synthesized neurobiological model across its subtypes. Leveraging the Triple Network Model of psychopathology, we sought to parse heterogeneity in dissociative experience by examining functional connectivity of three core neurocognitive networks as related to: (1) the dimensional dissociation subtypes of depersonalization/derealization and partially-dissociated intrusions; and, (2) the diagnostic category of dissociative identity disorder (DID). Participants were 91 women with and without: a history of childhood trauma, current posttraumatic stress disorder (PTSD), and varied levels of dissociation. Participants provided clinical data about dissociation, PTSD symptoms, childhood maltreatment history, and completed a resting-state functional magnetic resonance imaging scan. We used a novel statistical approach to assess both overlapping and unique contributions of dissociation subtypes. Covarying for age, childhood maltreatment and PTSD severity, we found dissociation was linked to hyperconnectivity within central executive (CEN), default (DN), and salience networks (SN), and decreased connectivity of CEN and SN with other areas. Moreover, we isolated unique connectivity markers associated with depersonalization/derealization in CEN and DN, to partially-dissociated intrusions in CEN, and to DID in CEN. This suggests dissociation subtypes have robust functional connectivity signatures that may serve as targets for PTSD/DID treatment engagement. Our findings underscore dissociation assessment as crucial in clinical care, in particular, to reduce gender-related health disparities.

The Multidimensional Inventory of Dissociation (MID) in Depersonalization Disorder: General Findings with a Clinical Emphasis on Memory and Identity Disturbances

ABSTRACT The Multidimensional Inventory of Dissociation (MID) was administered to 23 participants diagnosed with DSM-IV-TR Depersonalization Disorder (DDD) by structured interview. The MID has not been previously examined in DDD and does not generate a diagnostic formula for the disorder. Mean MID score for the sample was modestly elevated at 18.54, and was significantly correlated with Dissociative Experiences Scale, Cambridge Depersonalization Scale, and Childhood Trauma Questionnaire scores. Criterion A (General Dissociation) Depersonalization and Depersonalization scale scores were markedly elevated (41.70 and 40.98 respectively), followed by moderate elevations in the Identity Confusion (36.01), Trance (25.44), and Memory Problems (23.30) scales. Criterion B (Intrusions from partly dissociated self-states) mean score was modestly elevated (19.13) and declined to 13.67 once items overlapping with the Depersonalization and Identity Confusion scales were excluded. Criterion C (fully dissociated manifestations of other self-states) mean score was minimally elevated (6.57). Of the 168 pathological dissociation items, 55 were clinically elevated in DDD. Closer examination of the Intrusions and Amnesia items that were modestly elevated in DDD revealed that these items did not reflect the presence of alters, but rather represented known depersonalization-related phenomena. We propose a preliminary formula, based on cutoff scores for Criterion A Depersonalization and/or Derealization, Criterion B, and Criterion C (≥20, ≤28, ≤11) for the sensitive diagnosis of DDD (82.6% of participants), which would require future investigation for replication and determination of specificity vis-à-vis the other dissociative disorders.

THE ACCEPTABILITY AND POTENTIAL BENEFITS OF A WEB-BASED PSYCHOEDUCATION PROGRAM FOR PEOPLE WITH PATHOLOGICAL DISSOCIATION: A PILOT EVALUATION STUDY

ABSTRACT Pathological dissociation is a common trauma-related condition and is associated with considerable health and social care needs. People with pathological dissociation typically require psychosocial interventions, but there are many challenges in providing such interventions for this vulnerable population. An important question that remains unexplored is whether web-based interventions are acceptable and beneficial for people with pathological dissociation. This paper reports the findings of a pilot evaluation study of a web-based psychoeducation program for people with pathological dissociation. A total of 80 participants were included. The preliminary findings revealed that: most participants were satisfied with the web-based program (e.g., most participants agreed that the program helped them understand [94.1%] and manage [66.7%] their mental health conditions and remain hopeful for recovery [78.4%]); and participants had improvements in symptom management (large effect; partial eta squared = .143) and self-esteem (medium-to-large effect; partial eta squared = .111) after the program. However, no improvements in clinical symptoms were observed on measures of post-traumatic or dissociative symptoms. The dropout rate at posttest was 36.3%. This is one of the first studies that evaluated web-based interventions for people with pathological dissociation. Although the web-based program is well-accepted by the participants and might be associated with some potential benefits, the limitations of this pilot study should be acknowledged. Implications are discussed in terms of the directions for future developments of the program and the needs for further evaluation.

Development and validation of the brief pathological dissociation scale PDS(B): Initial psychometrics

The goal is to validate a brief scale for pathological dissociation (PDS-B). Using a longitudinal design, 229 participants completed a questionnaire that included the brief dissociation experience scale (DES-B), the PDS-B, international trauma questionnaire, Beck depression inventory, cumulative traumas, and will to exist, live, and survive scales, in times 1 and 2. We used correlation, exploratory in time one, confirmatory factor analyses in time two, and hierarchical multiple regression to analyze the data. Results indicated that the PDS-B has good construct validity, reliability, test-retest stability, convergent, discriminant, criterion, and predictive l validity. It had robust incremental validity as its effect sizes on predicting CPTSD, PTSD, and depression were medium to large, compared to the relatively lower effect sizes of other predicting variables. The measure seems to be a good screening tool for pathological dissociation.

Trouble de stress post-traumatique et symptômes dépressifs : « comorbidités » ou formes cliniques du trauma ? Description de la dépression dissociative.

We investigate the epidemiology of depressive disorders, on the one hand, and post-traumatic disorders, on the other hand, in order to better understand the relationship between the two. The evolution of a semiological and a psychopathological understanding of post-traumatic psychic disorders, which cannot be reduced to post-traumatic stress disorder alone, allows us to understand the nosographic framework of post-traumatic depression. Over time, under the effect of traumatic dissociation, the cardinal symptoms of reliving, avoidance and hypervigilance can give way to various syndromes whose psychotraumatic origins remain unknown. This is no doubt the cause of many cases of resistant depression. These are neither depressive “comorbidities” nor “complications” but authentic clinical forms resulting from trauma and remaining linked to it by anamnestic, psychopathological and neurobiological factors. In this study, we enumerate the now classic post-traumatic depressions: (i) psychophysiological exhaustion in the face of the trauma and its consequences, (ii) mood-congruent psychotic characteristics, (iii) depressions masked by somatic suffering, (iv) those that involve post-traumatic grief. Also, we suggest that pathological dissociation creates depressogenic cognitive patterns to the point of leading to “dissociative depressions”. We then discuss the therapeutic perspectives of pharmacological and psychotherapeutic treatments, and finally address research strategies based on psycholinguistics, and in particular the description of traumatic psycholinguistic syndrome (SPLIT). We conclude with a discussion of the medico-legal issues.

The Molecular Genetics of Dissociative Symptomatology: A Transdiagnostic Literature Review.

Dissociative disorders are a common and frequently undiagnosed group of psychiatric disorders, characterized by disruptions in the normal integration of awareness, personality, emotion and behavior. The available evidence suggests that these disorders arise from an interaction between genetic vulnerability and stress, particularly traumatic stress, but the attention paid to the underlying genetic diatheses has been sparse. In this paper, the existing literature on the molecular genetics of dissociative disorders, as well as of clinically significant dissociative symptoms not reaching the threshold of a disorder, is reviewed comprehensively across clinical and non-clinical samples. Association studies suggest a link between dissociative symptoms and genes related to serotonergic, dopaminergic and peptidergic transmission, neural plasticity and cortisol receptor sensitivity, particularly following exposure to childhood trauma. Genome-wide association studies have identified loci of interest related to second messenger signaling and synaptic integration. Though these findings are inconsistent, they suggest biologically plausible mechanisms through which traumatic stress can lead to pathological dissociation. However, methodological concerns related to phenotype definition, study power, and correction for the confounding factors limit the value of these findings, and they require replication and extension in studies with better design.

Trauma-Related Dissociation and the Dissociative Disorders:

Trauma-related dissociation is a major public health risk warranting the attention of the healthcare professions. Severe dissociative pathology or dissociative disorders (DDs) are more prevalent than some commonly assessed psychiatric disorders (e.g., Bipolar Disorder, Obsessive Compulsive Disorder, Schizophrenia), yet are often under-recognized and undertreated, despite being associated with significant disability and chronic medical issues, among many other severe and costly public health consequences. In fact, people living with DDs spend an average of 5 to 12.4 years actively engaged in treatment before receiving an accurate diagnosis. Detection and treatment of trauma-related dissociation and DDs leads to a myriad of positive outcomes including improved quality of life, treatment outcomes, reduction in health and social risks, decreased healthcare utilization and costs (25-64% reduction), and significant economic advantages for society. It is imperative that healthcare professionals are trained in recognizing, assessing, and treating dissociation in service of preventing the discussed public health consequences. This article provides a comprehensive review of the important public health implications resulting from often neglected or untreated trauma-related dissociation and DDs while offering a summary of assessment methods, treatments, and resources to empower individuals and healthcare professionals to effect change.