Constance J. Dalenberg

Evaluation of the Evidence for the Trauma and Fantasy Models of Dissociation

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.

A Conceptual Framework for the Impact of Traumatic Experiences

This conceptual framework for the effects of traumatic experiences addresses what makes an experience traumatic, what psychological responses are expected following such events, and why symptoms persist after the traumatic experience is over. Three elements are considered necessary for an event to be traumatizing: The event must be experienced as extremely negative, uncontrollable, and sudden. The initial core responses to trauma include reexperiencing and avoidance symptoms that occur across four modes of experience. Explanations of how each response is theoretically linked to traumatic events are offered to clarify how the responses reflect the natural human response to uncontrollable, negative, and sudden events. The framework delineates the behavioral learning and cognitive processes that elucidate the persistence of the initial response to trauma. Five factors are proposed that influence the response to trauma, including biological factors, developmental level at the time of trauma, severity of the stressor, social context, and prior and subsequent life events. Finally, secondary and associated responses to trauma are discussed that are common across many types of traumatic experience. These include depression, aggression, substance abuse, physical illnesses, low self-esteem, identity confusion, difficulties in interpersonal relationships, and guilt and shame.

Multivariate prediction of posttraumatic symptoms in psychiatric inpatients

Based on a conceptual framework for the long-term effects of childhood abuse, this study examined the capacity of childhood family environment (caretaker dysfunction, neglect, perceived social support), violent abuse (physical and sexual), and individual variables (other abuse) to predict adult psychiatric symptoms of PTSD, dissociation, and depression. Complete interview data were obtained from 178 psychiatric inpatients who varied greatly on abuse status and severity. Results of multiple regressions of predictor variables onto the three outcome variables showed that the predictor variables accounted for 15% (for depression) to 42% (for PTSD) of the variance in these symptoms and that violent abuse uniquely accounted for a significant proportion of the variance in outcomes for all three of the symptom groups studied.

Reality Versus Fantasy: Reply to Lynn et al. (2014)

We respond to Lynn et al.s (2014) comments on our review (Dalenberg et al., 2012) demonstrating the superiority of the trauma model (TM) over the fantasy model (FM) in explaining the trauma-dissociation relationship. Lynn et al. conceded that our meta-analytic results support the TM hypothesis that trauma exposure is a causal risk factor for the development of dissociation. Although Lynn et al. suggested that our meta-analyses were selective, we respond that each omitted study failed to meet inclusion criteria; our meta-analyses thus reflect a balanced view of the predominant trauma-dissociation findings. In contrast, Lynn et al. were hypercritical of studies that supported the TM while ignoring methodological problems in studies presented as supportive of the FM. We clarify Lynn et al.s misunderstandings of the TM and demonstrate consistent superiority in prediction of time course of dissociative symptoms, response to psychotherapy of dissociative patients, and pattern of relationships of trauma to dissociation. We defend our decision not to include studies using the Dissociative Experiences Scale-Comparison, a rarely used revision of the Dissociative Experiences Scale that shares less than 10% of the variance with the original scale. We highlight several areas of agreement: (a) Trauma plays a complex role in dissociation, involving indirect and direct paths; (b) dissociation-suggestibility relationships are small; and (c) controls and measurement issues should be addressed in future suggestibility and dissociation research. Considering the lack of evidence that dissociative individuals simply fantasize trauma, future researchers should examine more complex models of trauma and valid measures of dissociation.

Statistical support for subtypes in posttraumatic stress disorder: the how and why of subtype analysis.

A number of researchers have argued for the existence of different subtypes of posttraumatic stress disorder (PTSD). In the current paper we present criteria by which to assess these putative subtypes, clarify potential pitfalls of the statistical methods employed to determine them, and propose alternative methods for such determinations. Specifically, three PTSD subtypes are examined: (1) complex PTSD, (2) externalizing/internalizing PTSD, and (3) dissociative/nondissociative PTSD. In addition, three criteria are proposed for subtype evaluation, these are the need for (1) reliability and clarity of definition, (2) distinctions between subtypes either structurally or by mechanism, and (3) clinical meaningfulness. Common statistical evidence for subtyping, such as statistical mean difference and cluster analysis, are presented and evaluated. Finally, more robust statistical methods are suggested for future research on PTSD subtyping.

Secret-Keeping Behaviors in Black and White Children as a Function of Interviewer Race, Racial Identity, and Risk for Abuse

Summary The tendency for children to keep the secret of child abuse is an important practical impediment to adequate research, prevention, assessment, and treatment. While some studies have established that children will readily keep adult secrets, few have investigated the predictors of ease of disclosure. In this research, race of the interviewer requesting the secret strongly affected disclosure, with Black children particularly showing an unwillingness to disclose a negative secret to a different race interviewer. Children at high risk for sexual abuse (as assessed by the Finkelhor checklist) also were more likely to keep the secret.

Dissociation and Physical Abuse as Predictors of Bulimic Symptomatology and Impulse Dysregulation

Abstract The current study examined the relationship between physical abuse, dissociation, bulimic symptomatology, and impulse dysregulation. Subjects were 126 female and 57 male undergraduate and graduate psychology students. Child physical abuse, as measured by the Violence History Questionnaire, was reported by 32% of the sample, The results of this study provide support for the role of violence history in predicting the presence and severity of bulimic symptomatology and impulse dysregulation. Additionally, violence effects were gender specific, yielding higher correlations to bulimia in men and impulsivity in women. Dissociation, though predictive of bulimia for women, did not clearly function as a mediator of violence history.

Poster Session Abstracts

A random sample of therapists (N=161) working in the field of trauma were surveyed to study levels of stress. Therapists were assessed on measures of general life stress, burnout, and traumatic stress. Twenty-four percent were experiencing high levels of general life stress, 16% reported high levels of emotional exhaustion, 26% felt ineffective in terms of personal accomplishment at work and 14% were experiencing high levels of traumatic stress similar to clients with post traumatic stress disorder. Relationships between measures and demographic variables were reported, a profile of traumatised therapists was identified, and implications of these findings of therapists were presented.

Recovered memory and the Daubert criteria: recovered memory as professionally tested, peer reviewed, and accepted in the relevant scientific community

Research during the past two decades has firmly established the reliability of the phenomenon of recovered memory. This review first highlights the strongest evidence for the phenomenon itself and discusses the survey, experimental, and biological evidence for the varying mechanisms that may underlie the phenomenon. Routes to traumatic amnesia from dissociative detachment (loss of emotional content leading to loss of factual content) and from dissociative compartmentalization (failure in integration) are discussed. Next, an argument is made that false memory is a largely orthogonal concept to recovered memory; the possibility of one phenomena is largely irrelevant to the potential for the other. Furthermore, some aspects of the false memory research offer supportive data for the recovered memory researcher. Finally, the issue of error rates in making the Daubert case is explored. It is concluded that the weight of the evidence should allow the recovered memory victim to come before the court.

Meta-analyses of clinical neuropsychological tests of executive dysfunction and impulsivity in alcohol use disorder

ABSTRACT Background: Promising models for cognitive rehabilitation in alcohol treatment rest on a more nuanced understanding of the associated impairments in the multifaceted domains of executive functioning (EF) and impulsivity. Objectives: This meta-analysis examined the effects of alcohol on the individual subcomponents of EF and impulsivity in recently detoxified participants, including 1) Inhibition & Self-Regulation, 2) Flexibility & Set Shifting, 3) Planning & Problem Solving, 4) Reasoning & Abstraction, and 5) Verbal Fluency. Impulsivity was further examined through an analysis of motor, cognitive, and decisional subcategories. Method: Investigators searched, coded, and calculated effect sizes of impairments demonstrated in a broad range of neuropsychological tests for EF. A total of 77 studies were selected covering 48 years of research with a sample size of 5140. Results: Findings ranged from a Hedges’ g effect size of 0.803 for Inhibition to a Hedges’ g of 0.359 for Verbal Fluency. Results also varied for the individual subcategories of Inhibition, including a large effect size for decisional impulsivity (g = 0.817) and cognitive impulsivity (0.860), and a moderate effect size for motor impulsivity (g = 0.529). The Hayling Test, Wisconsin Card Sorting Test, and Iowa Gambling Task were the measures most sensitive for alcohol effects. Conclusion: 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.