The author addresses how psychoanalysts sometimes create theories enabling the treatment of conditions which they themselves fail to acknowledge. When working with trauma clinicians are subject to disavowal, denial, detachment, and/or dissociation. Papers by Bion, Bowlby, and Freud are discussed for their clinical interest and how their theories prevented them from making use of their own ideas. Bion's outlining of the impact of hierarchy and conformity aids trauma work and its connection to whistleblowing although he didn't discuss child abuse. Bowlby regretted avoiding child abuse yet his work on attachment and loss benefits trauma workers. Freud's avoidance of externality such as socio-political embedded ideas on family and class prevented him from addressing the impact of reality on the structuring of mind. The author identifies examples from her own work illustrating where internalized theory aided her work with patients and where the impact of patients' trauma prevented her from using the tools at her disposal.

The author discusses the break interpersonalists made with Freud's drive, defense, fantasy model by shifting the focus of inquiry to what occurs between people creates mind while retaining Freud's concepts of transference, countertransference, dream interpretation and the unconscious. Additionally, they acknowledged influences from culture, class, and religion as contributing factors to the organization of family structure and individual minds. The relational school bifurcated psychoanalytic theory into the drive structure model (Freudian theory, Ego Psychology), and the relational structure model (interpersonal school, British Object Relations, and SelfPsychology). Its strength lies in its recognition that interactions in the interpersonal world effects the formation of mind along with object relations theory emphasizing that intrapsychic structure influences perceptions and interactions in the relational world. Since both schools of thought acknowledge Sandor Ferenczi as their progenitor, a brief discussion of his influential contributions is offered.

Sándor Ferenczi's contribution recognizes the relevant interpersonal aspects and intersubjective dialogue as central to psychoanalytic theory and clinical practice. Through his theoretical, clinical and technical studies, he has developed numerous notions in relation to trauma, the effects of its disavowal and its impact exceeding the victim's capacity for understanding and symbolization. After about 50 years of forced oblivion, Ferenczi's thought has regained full recognition since 1990s among the wider psychoanalytic and clinical community in general. Authors analyze Ferenczi's fundamental intuitions on the and trauma, dissociative, and defensive processes, understood as a dysfunctional interpersonal process that undermines the capacity to make sense of experience. Consequently, healing can only occur through new and functional relational experiences within a sincere and affective therapeutic relationship. The latter, moreover, is seen as an exercise in reflective thinking in the form of participatory dialogue that helps the patient to develop, trust, reflective capacity and to integrate his personality.

Contemporary approaches to trauma tend to minimize or even overlook a psychodynamic perspective to treatment. The challenge for the clinician is sensing when such interventions might help or hurt. This chapter illustrates this dilemma by drawing upon the author's experience, both personal and professional, in arriving at some basic principles. The synthesis of his experience on an inpatient dissociative disorders unit with his long-term analytic work in the outpatient setting is a treatment model, Psychoactive Psychotherapy. It is a six stage, transference-based approach, addressing the autohypnotic nature of dissociation as a defense. Integration of the compartmentalized self-states (alters) is facilitated through the delineation of the "mosaic transference" and the therapist's capacity for containment.

Therapeutic play is a foundational discovery from psychoanalysis and is now a major contribution to child treatment in all its forms. Underacknowledged derivatives from child's play in adult treatments include: the attention to principles of development; the application of nonverbal relational process; utilization of somatic movement; and above all, the therapeutic engagement with child self-states in the full spectrum of dissociative disorders. This case report describes psychoanalytic play with a therapist/analyst who is schooled in principles of trauma treatment and its dissociative manifestations as well as principles of dyadic, countertransferential attentiveness. The treatment mode - child psychoanalysis - allows for a natural integration of other forms of trauma work while still , in all the twists and turns that her treatment illustrates and which both adult and child psychoanalysis privilege so uniquely.

This paper examines the relationship between psychoanalysis and trauma, focusing specifically on dissociation-and, more narrowly, on , the most challenging form for psychoanalysis to address. Dissociative multiplicity involves the presence of more than one center of consciousness, more than one "I," a feature of multiple personality, now called Dissociative Identity Disorder or DID, and OSDD-1, or subthreshold DID. The central question is whether classic psychoanalytic constructs, such as splitting, repression, various triadic views (oedipal, topographic, structural, Fairbairnian, Kohutian), object relations, and attachment theory, can adequately account for dissociative multiplicity. I explain how they cannot, but also how they remain applicable to multiplicity. I conclude with a summary view and reflection on what still needs to occur to reintegrate dissociation into mainstream psychoanalytic theory and practice.

Sandor Ferenczi contributed some of the best formulations of complex trauma and dissociation that exist. No one has described more passionately than Ferenczi the traumatic induction of dissociative trance with its resulting fragmentation of the personality. His concept of (which differed significantly from Anna Freud's later concept using the same term) describes how the traumatized child splits/dissociates the perpetrating aspects from the nurturing aspects of the aggressor and internalizes these in separate self-states, enabling the traumatically overwhelmed child to maintain a bond of tenderness with the aggressor. This article applies Ferenczi's concept of identification with the aggressor, along with some of Freud's and Bion's concepts of group dynamics, to the bond with and appeal of authoritarian leaders to their followers. Here, we find both dissociated parts that Ferenczi described operating in tandem, involving an idealization of the aggressor simultaneous with the enactment of aggressor-identified parts.

Freud's instinct theory and Bowlby's attachment theory are generally seen as oppositional approaches. Most crucially, the two theories sharply differ on the question of internal vs. external origins of trauma: whether trauma originates from intra-psychic conflict between innate instincts (Freud), or from various degrees of relational deficiencies in the attachment figure's attentiveness and subsequent protection of the child from actual harm (Bowlby). This disagreement is often deemed completely unbridgeable. This paper, however, views the two theories as two links in a lineage of ideas rather than two opposites, as it follows the gradual shift of psychoanalytic emphasis from innate instincts to external objects; through objects to the Self; and from phantasy relationship to the crucial impact of actual relationships.

The Guest Editors provide an overview of the papers appearing in this issue of the Journal of Trauma and Dissociation. Freud's opus with its emphasis on fantasy while appreciated as a vital contribution to the establishment of psychoanalysis, essentially "dissociates" the effect of exogenous trauma on the dissociative structure of the mind. The Guest Editors argue that the papers in the current issue support the idea that exogenous trauma and the resulting dissociative structuring of the mind play a significant role in the development of psychopathology.

This study explores the mental health impact of potentially traumatic events (PTEs) during wartime, focusing on the prevalence and severity of post-traumatic stress disorder (PTSD) and dissociative symptoms among a sample of 1,511 Israeli adults exposed to the recent war. Data were collected during the third month of the Israel-Hamas war. Our findings reveal elevated clinical PTSD symptoms (36.8%) and dissociation (16.3%) across the population, including 17.8% of individuals not directly exposed to trauma who nonetheless reported PTSD symptoms above the clinical threshold. These results challenge the adequacy of DSM-5 Criterion A in ongoing conflict contexts, where indirect exposure can contribute significantly to psychological distress. Furthermore, participants exposed to three or more PTEs demonstrated markedly higher PTSD and dissociative symptoms, emphasizing the cumulative burden of repeated trauma. These findings suggest that clinicians must consider both the number and nature of PTEs when developing treatment plans. Additionally, mental health policies should account for the psychological effects of indirect trauma, particularly in settings of ongoing conflict, where the entire population is at risk. The study highlights the urgent need for tailored interventions that address the complex and enduring mental health challenges associated with both direct and by-proxy trauma exposure.

In this clinical contribution, we describe the application of Dialectical Behavior Therapy (DBT) for managing dissociative symptoms in individuals with posttraumatic stress disorder (PTSD). We examine how DBT, a treatment originally designed for life-threatening behaviors, can be tailored to address the complex needs of PTSD patients with dissociative symptoms. Through clinical vignettes, we illustrate the application of DBT modifications that enhance emotional stabilization, integrate mindfulness, and build distress tolerance to manage dissociative episodes. The vignettes demonstrate both the challenges encountered and the therapeutic breakthroughs achieved. We discuss how integrating DBT into trauma-informed care frameworks can improve emotional regulation and resilience, highlighting the therapy's effectiveness in fostering recovery and emphasizing the importance of personalized treatment strategies for trauma-related dissociation.

This study aimed to validate the Italian version of the Multiscale Dissociation Inventory (MDI-ITA) and to assess its psychometric properties in a non-clinical sample. The MDI was translated and culturally adapted following established guidelines. A total of 439 Italian-speaking adults participated in the study and filled out the MDI-ITA and other assessment tools for dissociation depression, anxiety, stress, and post-traumatic symptoms. The internal consistency, test-retest reliability, and construct validity of the MDI-ITA were evaluated using exploratory and confirmatory factor analyses. Consistent with previous validation studies, the analyses supported a five-factor structure: Disengagement, Depersonalization/Derealization, Emotional Constriction, Memory Disturbance, and Identity Dissociation. Cronbach's alpha values for each subscale were all greater than 0.71, demonstrating satisfactory internal consistency. Test-retest reliability was also high, with a correlation of 0.91. Convergent validity was supported by significant positive correlations between MDI-ITA and other dissociation measures. Discriminant validity was indicated by weaker correlations with depression, anxiety, and post-traumatic symptoms. The MDI-ITA is a reliable and valid tool for assessing dissociative phenomena in Italian-speaking populations with potential applications in both clinical and research settings. Its multidimensional structure offers comprehensive insights into dissociation, facilitating the development of targeted interventions for individuals presenting with these symptoms.

This article examines the interconnections among attachment trauma, dissociation, and addictive behaviors from a psychodynamic perspective. Drawing on contemporary theoretical and empirical developments, we contend that early adverse experiences - such as neglect, abuse, and inconsistent caregiving - disrupt the formation of secure internal working models of attachment and impair affect regulation. This disruption prompts a dissociative reorganization of the self, emerging as a defensive process that compartmentalizes traumatic memories and mitigates overwhelming emotional distress. Although initially adaptive, dissociation may become entrenched, resulting in fragile self-cohesion and a maladaptive reliance on external regulatory strategies. Within this framework, addictive behaviors are conceptualized not merely as compulsive or reward-driven phenomena but as compensatory mechanisms that externally manage dysregulated affect while simultaneously maintaining the segregation of traumatized mental states. The clinical implications of this model underscore the need for integrative interventions for individuals who display addictive behaviors that address their underlying attachment trauma, thereby fostering self-cohesion, emotional integration, and more adaptive self-regulation strategies.

Earthquakes are strong and unpredictable traumatic events that significantly affect people and the environment. The two major earthquakes in Turkiye on February 6, 2023, affected 11 cities and caused many injuries and deaths. This study investigates dissociative symptoms and sleep problems in children and adolescents who lost their close relatives in these earthquakes. The study sample consisted of children and adolescents affected by the Kahramanmaraş earthquake and applied to the Child and Adolescents Psychiatry Department of Adana City Research and Training Hospital, Adana, Turkiye. The study included 72 children and adolescents in the patient group and 68 in the control group, aged between 10 and 17 years. The Adolescent Dissociative Experiences Scale (A-DES) was used to assess dissociative symptoms, while the Children's Sleep Habits Questionnaire (CSHQ) was used to determine sleep difficulties. An experienced child and adolescent psychiatrist thoroughly examined all the children. All dimensions of A-DES were significantly higher in children and adolescents affected by the earthquake. The patient group showed higher total CSHQ score and subscores (sleep onset delay, sleep anxiety, night wakings, and parasomnias). The total CSHQ score and subscores (night wakings and parasomnias) were positively correlated with the A-DES total score among children and adolescent victims. Regression analysis showed that hospitalization and CSHQ total score had positive relationships with the A-DES total score. Sleep disorders and dissociation can be seen in children and adolescents after natural disasters. Dissociative symptoms may be positively linked with hospitalization and sleep problems.

Child sexual abuse has repeatedly been identified as a risk factor for suicidal ideation and behavior, yet most research has focused on adolescents and young adults. Very little is known about suicidality in children exposed to sexual abuse in middle childhood, which is a developmental period marked by unique cognitive and socioemotional specificities. Gaining a better understanding of risk factors in this subgroup is crucial to inform age-appropriate prevention and intervention efforts. This study aimed to: 1) determine the prevalence of suicidal ideation and behavior in a sample of child victims of sexual abuse aged 6-12 years old, using both self- and parent-reports and 2) model a regression tree to identify the most potent markers of suicidal risk. A total of 783 children aged 6-12, and their non-offending caregivers, completed questionnaires on suicidality, and correlates of suicidal risk (e.g. depression, emotional regulation, post-traumatic stress symptoms, and perceived maternal support following disclosure of abuse). The prevalence of suicidal ideation was 31.2% and 11.4% according to children and parents, respectively. Findings revealed that emotional dysregulation and clinical levels of depression were the most influential variables in the prediction of suicide risk. Namely, the subgroup that showed the highest suicidal risk consisted of children who had both high levels of emotional dysregulation and clinical levels of depression. The decision tree model offers an important screening tool for clinicians wishing to identify children most at-risk of suicidality.

Childhood traumas such as childhood abuse and neglect are prevalent in Hispanic populations. They have long-term consequences including posttraumatic stress symptoms (PTSS) in adulthood. Treatment options suitable for Hispanic survivors of childhood traumas and neglect are needed. Expressive writing (EW) can be a short, self-administered intervention and may address instrumental barriers (e.g. time, transportation) and stigma toward psychological disorders and interventions Hispanic trauma survivors may experience. Online EW has successfully reduced PTSS when targeting mixed traumas but has not been tested for PTSS from childhood traumas. The current study administered an online EW protocol to symptomatic Hispanic young adults with either childhood trauma or adult trauma. A longitudinal multilevel modeling approach was used to examine the effects of online EW on PTSS at 1-week, 1-month, and 3-month follow-ups. EW reduced PTSS in both groups at 1-week follow-up and therapeutic gains were maintained up to the 3-month follow-up. The current study provides evidence supporting EW as a short-term, self-administered intervention strategy suitable for Hispanic individuals with PTSS due to childhood trauma or adult trauma.

Dissociation is a prevalent phenomenon. Existing psychometric tools for measuring dissociation have faced several criticisms. The Dissociation Questionnaire (DIS-Q) is a noteworthy tool but suffers from being lengthy (63 items) and including non-pathological components of dissociation. This study aims to develop a shorter version of the DIS-Q (sDIS-Q) that focuses on the core pathological manifestations of dissociation.

Currently, the diagnosis of posttraumatic stress disorder necessitates exposure to a traumatic event as defined by DSM-5-TR Criterion A. Nevertheless, evidence suggests that experiences not meeting Criterion A stressor definitions, specifically related to intimate relationships (e.g., psychological abuse) can also elicit clinically significant posttraumatic stress symptoms (PTSS). However, the literature examining the unique role of non-Criterion A intimate relationship stressors on PTSS is sparse. This systematic review synthesized the literature examining the influence of non-Criterion A intimate relationship stressors on PTSS. Electronic searches of three databases (i.e., PsychInfo, Scopus, and PubMed) identified 3257 articles which underwent title and abstract screening and, if potentially eligible, full-text review. Nine articles met inclusion criteria; four of which examined PTSS after a conflict in a relationship and/or divorce, two studies focused on infidelity, and three studies focused on partner psychological abuse in an intimate relationship. Results revealed that relationship conflict and divorce, infidelity, and psychological abuse can lead to clinically significant PTSS, however, these findings were not consistent across all studies. Findings reveal considerable variability in the frequency and severity of PTSS following non-Criterion A intimate relationship stressors that is in line with the variability found in Criterion A-exposed samples. Nevertheless, given the limited number of studies identified, further research is needed. Understanding the impact of these stressors may have important implications for diagnostic and treatment considerations and will provide valuable insights for our understanding of the PTSD construct in its entirety.

Military Sexual Trauma (MST) affects a large number of female veterans and is associated with various adverse physical and mental health conditions. Sexual trauma can lead to pelvic floor dysfunction, contributing to lower urinary tract symptoms (LUTS), a common urological concern, and fecal incontinence (FI). LUTS and FI may have a higher prevalence among female veterans with MST.

This study examined autobiographical reasoning and three aspects of global coherence (i.e. temporal, causal-motivational, thematic) of life narratives in individuals with dissociative identity disorder (DID) assessed in both adult and child identity states ( = 13), a psychotic disorder ( = 18), general population adults ( = 49) and children ( = 26), and adults simulating being a child ( = 23). DID participants did not significantly differ between identity states in narrative coherence or autobiographical reasoning if additional predictors were included, although differences in causal-motivational coherence were found if total number of memories in the life-narrative was low. Both DID and psychosis groups displayed less temporal and causal-motivational coherence than non-psychiatric adults, with DID adults also showing less thematic coherence. Individuals with DID in child states demonstrated less temporal coherence than non-clinical child-simulators. Individuals with DID may have reduced coherence of narrative identity that does not differ between identities.

Dissociative Identity Disorder (DID) is increasingly depicted on popular online platforms such as TikTok. The present study aimed to analyze the portrayal of DID symptoms on TikTok, by comparing the frequency of clinical DID symptoms displayed in these videos to clinical data. Five popular DID-related hashtags were identified and a sample of 55 videos per hashtag were randomly selected to be analyzed ( = 249). Video engagement metrics and content-creator descriptives were gathered, and the core clinical symptoms of DID were assessed based on the Multidimensional Inventory of Dissociation (MID). The frequencies of DID symptoms in the TikTok videos were compared to a sample of 41 patients with a DID diagnosis clinically confirmed by the SCID-D-R (Dell, 2006). Results showed that most content was produced by creators with unknown credentials, and very few videos were from mental health professionals. Memory problems (amnesia) were the most frequently reported symptom in both samples, however no other symptoms occurred at the same relative frequency. In the DID-related TikTok videos all symptoms apart from amnesia were presented at <10% frequency, compared to having >75% occurrence in the clinical sample. The representation of DID on TikTok is not fully representative of clinical data and does not cover the full scope of clinical DID symptoms.

Disaffiliating from an ultra-Orthodox society is a risk factor for psychological distress, depression, and suicide ideation because the process involves encountering culture shock, education gaps, and disconnection from familiar surroundings. Traumatic experiences such as sexual abuse may augment distress among ex-ultra-Orthodox individuals (ex-ULTOIs).

Posttraumatic Stress Disorder (PTSD) is often comorbid with depression in both the general population and among veterans who have experienced combat trauma. However, there is a lack of studies inquiring into the comorbidity of prolonged PTSD and depression. The network paradigm offers a novel approach to studying this comorbidity via bridge symptom analysis. This study explores the bridge symptoms between depression and prolonged/chronic PTSD in patients diagnosed with both conditions, 10 years after trauma exposure, using network analysis. The sample consisted of 60 male, treatment-seeking veterans (aged 31 to 59) with diagnoses of both depression and PTSD. Bridge nodes detected in the present bridge symptom analysis include reduced sleep, inner tension, poor concentration/concentration difficulties, pessimistic and suicidal thoughts, distressing dreams, restricted range of affects, and agitation. The detected bridge nodes could partially be attributed to the characteristics of the sample, which consisted of patients diagnosed with PTSD comorbid with depression.

Interoceptive accuracy, the valid perception of internal bodily states, is believed to be negatively impacted by trauma. Current theories suggest that interoceptive accuracy may worsen when experiencing some PTSD symptoms (e.g. dissociation) but strengthen when experiencing other PTSD symptoms (e.g. hyperarousal). The goal of this study was to test a novel ambulatory method for measuring interoceptive accuracy and assess whether PTSD symptoms (dissociation, hypervigilance, exaggerated startle, and flashbacks) impact interoception. Trauma-exposed adults ( = 80;  = 39 diagnosed with PTSD) completed 3 days of ecological momentary assessment (EMA;  = 2,158 observations) while wearing a mobile electrocardiogram collecting passive heart rate data (interbeat interval; IBI). Momentary (within-person) fluctuations in subjective physical sensations (racing heart, sweating, trouble catching breath, feeling shaky, feeling tense) and PTSD symptoms were assessed via EMA, whereas trait (between-person) differences in PTSD severity were measured with the Clinician Administered PTSD Scale-5 (CAPS-5). Multilevel models provided mixed support for hypotheses that momentary PTSD symptoms would predict moment-to-moment fluctuations in interoception. Flashbacks were associated with better interoceptive accuracy, but hyperarousal symptoms were not. Interoception was significantly better during moments with lower-than-average dissociation symptoms, but only among people with low CAPS-5 scores. A limitation of the study is that we used a single cardiac measure (IBI) to predict a mix of physical sensations, some of which are not cardiac-related. Future research should continue to narrow the subjective report of physical sensations and take objective assessment of interoception out of the laboratory and into the daily lives of trauma survivors.

This study aims to assess the mediating effect of childhood trauma and dissociative experiences on the relationship between self-reported ADHD symptoms during childhood and adulthood in two separate cross-sectional studies. In Study 1, undergraduate students completed an online survey including a sociodemographic form, the Adult ADHD Self-Report Scale (ASRS), the Wender Utah Rating Scale (WURS), the Childhood Trauma Questionnaire (CTQ), and the Dissociative Experiences Scale (DES). Data from 1,148 participants were analyzed using descriptive statistics and mediation analysis. In Study 2, sociodemographic, clinical, and diagnostic data from 202 adults with ADHD, followed at the Adult Neurodevelopmental Disorders Clinic at Selçuk University, were analyzed. Diagnostic evaluations were conducted using the Structured Clinical Interview for DSM-5 Clinician Version. Clinical data included age, gender, years of education, comorbid conditions, and current ADHD medication use. The same self-report scales (ASRS, WURS, CTQ, and DES) were administered in both studies. The two samples differed significantly in terms of clinical characteristics and self-reported symptoms. Current ADHD symptoms were not only directly associated with childhood ADHD symptoms but also indirectly associated with them through increased childhood trauma and dissociative experiences, independent of demographic and clinical confounding factors in both studies. The pathway involving childhood trauma and dissociation may partially mediate the persistence of ADHD symptoms from childhood to adulthood in both undergraduate and adult ADHD samples. Longitudinal clinical studies are needed to better understand how the childhood trauma and dissociation pathway may influence the persistence of ADHD symptoms as individuals age, potentially extending into adulthood.

The aim of the study was to assess the severity of dissociative disorders in patients diagnosed with schizophrenia and their relationship to schizophrenia symptoms. The role of trauma in the relationship between these symptoms was also analyzed. It was also investigated whether dissociative fragmentation is a separate phenomenon from detachment in schizophrenia-spectrum disorders. The study group comprised 63 individuals with schizophrenia spectrum disorders (ICD-11), without organic disorders or addiction diagnoses, receiving treatment in Krakow health centers. The Polish versions of the following instruments were used: Positive and negative syndrome Scale (PANNS), Addenbrooke's Cognitive Examination (ACE - III), The Mindful Attention Awareness Scale (MAAS), Depression Anxiety and Stress Scale (DASS-14), Traumatic Experiences Checklist (TEC), Dissociative Experiences Scale Revised (DES-R), The Somatoform Dissociation Questionnaire (SDQ-20), Detachment and Compartmentalization Inventory (DCI) and Dissociative Symptoms Scale (DSS). Altogether 33.3% of the participants were identified as having elevated dissociative symptoms. They differed significantly from low scorers in severity of positive symptoms, mindfulness and experienced traumas. The severity of fragmentation and detachment symptoms correlated strongly. Numerous moderate positive correlations were found between dissociation symptoms and anxiety and depression symptoms, number of traumas experienced, psychopathological symptoms, and stronger negative correlations with mindfulness. A significant mediation effect of dissociation symptoms was found between traumatic experiences and psychopathological symptoms. Among people with schizophrenia, there is a subgroup with pronounced dissociative disorders and they are connected with traumatic experiences they had. Mindfulness should be researched in terms of its potential benefits in treatment of this group.

Postural orthostatic tachycardia syndrome (POTS) is a disorder of the autonomic nervous system (ANS) that primarily impacts females. This study explored the relationship between early relational trauma, internalizing symptoms, and autonomic dysfunction in females with POTS. Previous research has established a link between childhood trauma and long-term health outcomes, but the specific impacts of relational trauma, particularly its physical and emotional manifestations, are less understood. Our findings revealed statistically significant correlations between childhood relational trauma, POTS-related symptoms, and internalizing symptoms (e.g. depression, anxiety, stress), suggesting a new perspective on autonomic dysfunction and potential treatment.