Describe and Evaluate Research that Highlights Factors Involved in the Development of Dissociative Experiences.

Dissociation is defined as “A structured separation of mental processes (eg thoughts, emotions, conation, memory and identity) that are ordinarily integrated” (speigel & Cardena, 1991). The capacity for dissociation seems to develop as a normal psychological process for imaginative ability and fantasy, but in many cases this dissociative capacity can be employed as a psychological coping mechanism. To this end it has been recognised that dissociation cannot be described as a singular phenomenon. Rather, there may exist a continuum of dissociative experiences, ranging from common, ‘normative’ episodes (such as daydreaming) to more severe pathological manifestations (eg dissociative identity disorder) and processes (Ross, 1996). It has also been widely accepted since the work of Janet (1889), and since backed up by much empirical research, that high levels of dissociative experiences in an individual often closely relate to a history of trauma (especially during childhood). Despite all of this interest and research into the existence of dissociative experiences and tendencies, many of the factors that are believed to develop into, and mediate them have received scant empirical scrutiny (Irwin, 1998).

Thus in order to try and understand the factors involved in the development of dissociative experiences, it is important to look at that research which exists, and also to evaluate it. By doing so we can decide how reliable current findings are, and more importantly how researches could be developed in order to give a more comprehensive and accurate account of dissociative experience development.

The first research is Affective Predictors of Dissociation II: Shame and Guilt by H.J. Irwin (1998). Its was to examine whether shame and guilt may act as a mediator between childhood traumas and reliance on a dissociative coping style. Irwin chose to on shame and guilt as they have been shown to be the most common resulting tendencies of childhood trauma (particularly Childhood Sexual Abuse, or C.S.A.) (Lewis, 1990). The underlying theory was that when the shame or guilt felt after such trauma cannot be resolved (eg by confronting the source) then it is suppressed to avoid serious cognitive impairment. Thus the dissociative episodes are the ‘self` trying to remove itself from the situation and negative feelings. There are already a number of potential problems with this model. Firstly it only looks at two of the resultant tendencies of childhood trauma in isolation (ignoring other possibilities such as grief, anxiety and anger). It may be the case that the development of dissociative experiences is the result of different tendencies, or even a combination of tendencies. Secondly the presented theory is based on a fundamentally Psychodynamic view which in turn is focussed not on childhood trauma, but much more directly on C.S.A. It may therefore be too much of a leap to suggest that the findings are as generalisable as Irwin believes.

Irwin used 103 off-campus (part-time) Psychology students, of which only 19 were male. There was an age range of 19-56 years old (with the mean being 36.4). They were administered a postal survey in 4 parts. The first was a general form asking age and gender. The second was a questionnaire in the form of the D.E.S. (Dissociative Experiences Scale). This is a 28-item self-report measure of the frequency of dissociative phenomena in day-to-day life. Each item has a score range of 1-100, signifying the percentage of time the participant has the nominated dissociative experience. The average score over the 28 items is then used as a total D.E.S. score between 1-100. The third and fourth parts were forms assessing shame and guilt. PFQ 2 (Personal Feelings Questionnaire) measures the frequency of guilt feelings and the incidence of shame experiences. It is a 22 point self-report of shame and guilt, with 10 shame items, 6 guilt items and 8 fillers. Each item is rated on a 5-point Likert scale (0-4), results for each grouping are the sum of the individual scores. ASGS (Adapted Shame/Guilt Scale) measures the degree to which one accepts being described as guilty or ashamed. It has 30 items (10 shame, 12 guilt, 8 fillers) and works with a 7 point Likert scale (1-7), the results for each grouping again being the sum of the individual item scores. Age and gender were taken into account as they have previously been shown to affect the prediction of dissociative tendencies and thus may have been a potentially confounding variable.

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Proneness to shame, proneness to guilt and age were all shown to contribute significantly to the prediction of dissociative tendencies. All independent variables but the ASGS shame score (so PFQ 2 shame, PFQ 2 guilt, ASGS guilt and age) were shown to significantly contribute individually to the prediction of D.E.S. scores. It was concluded that dissociation could be predicted by the extent that a person deems themselves describable as guilty, as well as the frequency of their feelings of shame and feelings of guilt. Therefore these could be seen as factors involved in the development of dissociative experiences. These findings are certainly not conclusive. Although it may be hypothesised that there may be a causal or mediating link between shame & guilt and Dissociative experiences, all that has been so far proved is comorbidity. It would need further research to actually prove any causal link and prove the hypothesised model, which is mere speculation. Moreover, the model itself is not validated. It has only been tested on non-clinical samples, and also needs to be tested using pathological dissociators in a clinical context.

The sample currently employed by Irwin was relatively small, and not fully representative. That they were all studying psychology may have given them an insight into the research, which may have effected their responses. The measures employed were very effective, and have a high degree of reliability, but there were a number of possible problems on the way they were administered. Self-report has a number of benefits, it is anonymous and therefore allows opportunity for truthful response in answering delicate questions. However, it is non-adaptive, and may ask the wrong questions or be worded in a way an individual cannot relate to. Moreover, Likert scales can prove to be open to relative interpretation, with participants considering the scores to have different significance or severity. Finally, the postal system meant there was no control over time taken, environment used, interruptions, or even order in which the questionnaires were undertaken (which can be important in psychometric testing).

The next research is The Relationship Between Dissociation and Personality by M.A. Ruiz et al (1999). In this study, the relationship between the Five Factor Model (F.F.M.) of personality and dissociative experiences was investigated, and an attempt was made to identify personality subtypes that were most prone. Again the research was based on the idea that dissociation has been consistently identified as a psychological response to traumatic events (especially in childhood). It was pointed out that high levels of dissociative experiences do not always lead to dissociative disorders, with studies into the subject reporting disparate findings ranging from 17% (Ray & Lukens, 1995) to 70% (Ross et al, 1990). It was suggested that there must then be another factor that is involved in the way dissociation develops (eg pathologically or not), and that this could be personality type. The participants were 719 undergraduate students all enrolled in psychology courses (282 male, 437 female). Over 4 semesters, the participants were administered testing packets in groups of 50-75 people. These packets contained D.E.S. (as previously mentioned), C.A.T. (Child Abuse and Trauma) scale and NEO-FFI (NEO Five Factor Inventory). C.A.T. scale is a 38 item self report measure on perception of home environment and caregiver treatment, with 3 sub-scales measuring sexual abuse, physical abuse and punishment. NEO-FFI is a 60 item self report to measure F.F.M. dimensions (neuroticism, extraversion, openness to experience, agreeableness and conscientiousness).

Significant relationships were found between all five factors of F.F.M. and D.E.S. total and factor scores. There was negative association between D.E.S. scores and extraversion, agreeableness and conscientiousness, but positive associations between D.E.S. scores and openness to experience and (in particular) neuroticism. 3 personality subtypes were identified with high dissociators; friendly-open, friendly-extravert and neurotic-open. In particular the neurotic-open personalities were associated with the various factors of psychopathology in D.E.S. (eg segment amnesia), and reported a significantly higher rate of C.S.A. What was deemed important was that the neurotic-open types did not experience more dissociative episodes than the other 2 prone types, but rather they experienced qualitatively different types of dissociative episode.

This is broadly a strong and well-rounded study. What is shown is that there is definitely a meaningful relationship between personality and dissociative experiences, and that there is very likely to be a difference between personality types, as well as the development of pathological versus non-pathological dissociation. The question of causality is also less of an issue, as personality is very likely to develop before dissociative experiences, and is more likely to effect how an individual responds to trauma. However, the relationship is still mere inference at this time. There is no way of proving a causal link with the current information, or even that the relationship identified is not merely coexistent due to a third factor (eg social support being affective or childhood trauma shaping personality and causing dissociation). Also there are the previous criticisms to be made over the use of Psychology students as participants (although the number was much better). The fact that they had the packets administered in such large groups may also have led to discussion about the contents before they were undertaken.

One important point to consider is that Ruiz et al suggest that pathological and non-pathological dissociation may be qualitatively different, yet tested only a non-pathological sample. Clinical testing with disordered participants may be a useful extension to this research. Such further research may help assess how personality type affects the development and even the presentation of dissociative experiences. It may be that different personality types simply display dissociation in different ways or styles (pathoplasticity).

Now that the employed style of evaluation for these researches has been established, it is not necessary to go into the same level of detail, and so the following researches will be presented in much more of a summarised form.

Psychopathology, Hypnotisability and Dissociation by E.J. Frischholz et al (1992), compared the differential hypnotisability of 4 clinical groups; Dissociative disorders (14 participants), Schizophrenia (13 participants), mood disorders (13 participants) and anxiety disorders (14 participants) and one ‘normal’ group (63 participants. What was shown was that hypnotisability of dissociative disorder patients was much higher than that of all other groups, and by using the whole of the Hypnotic Induction Profile (H.I.P.), as well as the Stanford Hypnotic Susceptibility Scale (S.H.S.S.) this finding was much more reliable than the previous research. It can be surmised that hypnotisability is therefore definitely involved in the development of dissociative pathologies. This may also, to some extent, help support the model suggested by Irwin (1998) in the first article, as the Psychodynamic view of dissociation is based on the ability to ‘self-hypnotise’ in order to defend the self (Sue, Sue & Sue, 2000). It is unfortunate that the D.E.S. was not run on the ‘normal’ group as this may have led to a better understanding of the differences between pathological and non-pathological dissociative experiences. Also, the samples for each clinical group were possibly too small.

A follow up to this research was Hypnotisability, Pain Threshold and Dissociative Experiences by Ağargűn et al (1998). Although this research had strong potential in suggesting that hypnotisability and pain thresholds may be involved in the development of dissociative experiences, it is not comprehensive enough to draw any real conclusions from. The measures of both hypnotisability and pain threshold employed were too specific and un-validated to support the hypothesised model. The theory still has some grounding in the results shown however, and further, more comprehensive research of this topic could prove valuable.

Relationship of Dissociation to Temperament in Men and Women by H.J. Grabe et al (1999) takes the question of ‘nature vs. nurture’ and applies it to the development of dissociative experiences. Character traits are believed to develop in response to environmental stimuli during childhood and adolescence. Temperament traits, on the other hand are considered to be genetically predisposed and innate. Psychiatric patients (N=191) and healthy participants (N=41) were evaluated for dissociative symptoms (D.E.S.), Temperament and Character (Temperament and Character Inventory, T.C.I.) and current psychopathology (SCL-90-R). Women and men were evaluated separately. For both genders, the character traits of self-transcendence and self-directness were the only two traits (temperament or character) that were significant (and independent) predictors of dissociation. This research is very useful as it gives very strong evidence that dissociative experiences develop as a result of environmental factors, and not due to some genetic disposition. If this is true it greatly narrows the search to understand this development. It is a great shame, however, that despite the obvious opportunity, Grabe et al did not specify if there were any differences between the pathological and non-pathological dissociators. It should also be noted that the research only shows a basis for the development of dissociation, and does not look at mediating factors (of which some may be genetic).

Traumatic Childhood Events, Perceived Emotional Support, and the Development of Dissociative Tendencies By Irwin (1996) looks at whether the previously mentioned link between childhood traumatic experiences and dissociative experiences is merely an artefact of emotional support during childhood. 239 adults were surveyed for incidence of traumatic childhood events, perceived availability of emotional support from intra- and extra-familial figures, and presence of dissociative experiences. The sample spread was good, and the factors surveyed were done so comprehensively but one criticism is that the Q.E.D. (Questionnaire of Experiences of Dissociation) used employs a system of dichotomous response which is non adaptive and can often oversimplify responses.

The results showed that the perceived availability of emotional support in childhood was a strong predictor of current dissociative experiences, but account of the support factor did not eliminate the relationship between childhood trauma and dissociative tendencies. Thus lack of emotional support can be seen to be an important mediator, but not a primary cause of the development of dissociative experiences. It is still seen to be an important factor in this development. It should be noted that the two measures used in this study for incidence of traumatic childhood events (Survey of Traumatic Childhood Events- S.T.C.E.) and Emotional Support (Childhood Emotional Support Scale- C.E.S.S.) are very new and not yet effectively understood for their psychometric properties. It is possible that replication of the study with different measures may provide different results.

Development and the Fragmented Self: Longitudinal Study of Dissociative Symptomology in a Nonclinical Sample by J.R. Ogawa et al (1997) was a long term study that looked at dissociation from a developmental psychopathology perspective. It looked at ‘high risk` children for poor developmental outcomes due to poverty. It measured the dissociative Symptomology of 168 participants 4 times over 19 years and investigated whether it was related to factors such as; trauma, sense of self, quality of early mother-child relationship temperament and intelligence. It found that age of onset, chronicity and severity of trauma were highly correlated and effectively predicted the level of dissociative experiences. It also found that avoidant and disorganised patterns of attachment were very strong predictors of dissociation. From the findings, Sroufe et al suggest that dissociation in childhood may be viewed as a more normative response, whereas dissociation in adolescence and early adulthood is more likely to be pathological in nature. This research was very ambitious, and has managed to effectively highlight many of the developmental factors involved in dissociative experiences, as well as serving to support a number of other theories, such as the importance of emotional support, and the qualitative difference between pathological and non-pathological dissociation. It may even suggest that the concept of a continuum as mentioned in the introduction is in fact false, and that pathological dissociative tendencies (such as depersonalisation and derealisation) and non-pathological dissociative experiences (like absorption or strong engrossment) are conceptually and statistically disparate (Irwin, 2001).

A number of other researches also broach this topic, such as looking at the attention and cognitive environments of high vs. low dissociators (Freyd et al, 1998). Many of them, however, suffer the problem which has been noted with many of the researches listed here: It is easy to find a correlation between dissociation and some other factor, but very hard to show that there is any sort of causal link. Thus it can be suggested that factors such as shame and guilt, personality type, hypnotisability, temperament, or emotional support are involved in the development of dissociative experiences with varying degrees of certainty, but the exact nature of that involvement is still often elusive. Moreover, there may be other problems inherent to the researches thus far produced involving many of the aspects that are taken to be certain. For example most studies use childhood trauma as a factor, but there is growing evidence that many such childhood memories are falsely created (Hyman et al, 1998). In tests on this phenomenon, approximately 25% of a normal population created such memories, and moreover D.E.S. scores have been shown to positively correlate to memory creation. It seems then that both research styles and fundamental principles will have to be revised and validated before any firm answers on this topic are found.

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