Dissociation : Vol. 7, No. 3 (Sept. 1994)
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Item access-status.open.access.listelement.badge Dissociation : Vol. 7, No. 3, p. 191-196 : A group for partners and parents of MPD clients part III: marital types and dynamics(Ridgeview Institute and the International Society for the Study of Dissociation, 1994-09) Benjamin, Lynn R.; Benjamin, RobertThis article examines the marital dynamics between MPD clients and their partners. It attempts to classify types of partners, describing seven categories: New Abusers, Caretakers, "Damaged Goods," Obsessives, Paranoids, Schizotypal Roommates, and Closet Dissociatives. Such a typology helps to broaden the therapist's awareness of the client's marital context, heightens understanding of homeostatic patterns in the marital relationship, and sensitizes the therapist to the potential for the undermining of the therapy by the partner or by the MPD mate. This sensitization facilitates the therapist's efforts to provide interventions that enhance the couple relationship, promote the growth of each individual, and prevent the sabotaging of the therapy by either partner.Item access-status.open.access.listelement.badge Dissociation : Vol. 7, No. 3, p. 197-200 : The effect of multiple personality disorder on anesthesia: a case report(Ridgeview Institute and the International Society for the Study of Dissociation, 1994-09) Moleman, Nico; Hulscher, Jan B. F.; Hart, Onno van der, 1941-; Scheepstra, Gert L.In the context of studies on the psychophysiological differences between alter personalities in patients with multiple personality disorder (MPD), a patient with diminished need for anesthetics, especially analgesics, during major surgery is described. Psychophysiologic study of MPD patients during anesthesia is recommended, as the relation between doses of medication and their effects can be directly assessed.Item access-status.open.access.listelement.badge Dissociation : Vol. 7, No. 3, p. 185-190 : Effective management of family and individual interventions in the treatment of dissociative disorders(Ridgeview Institute and the International Society for the Study of Dissociation, 1994-09) Chiappa, FrancisWhile individual therapy is the primary treatment for multiple personality disorder (MPD} and dissociative disorder (DD) family interventions are necessary in many cases. A review of the relevant literature finds it lacking in three areas: a family systems perspective, an appreciation of the fundamental differences between individual and family therapy, and a clear position on the degree to which family sessions should focus on the MPD/DD symptoms. These shortcomings are discussed, a typical MPD/DD family configuration is described, and suggestions for effective family interventions are offered. While many therapists choose to provide both individual and family interventions in a case, it is argued here that this arrangement creates more problems than it solves. An alternative is the management of the two contrasting modalities by a treatment team.Item access-status.open.access.listelement.badge Dissociation : Vol. 7, No. 3, p. 178-184 : Inpatient cognitive behavioral treatment of eating disorder patients with dissociative disorders(Ridgeview Institute and the International Society for the Study of Dissociation, 1994-09) Levin, Andrew P.; Spauster, EdwardAlthough several investigations have noted an association between eating disorders and dissociative disorders, little work has addressed the treatment of patients with both conditions. As an inpatient service focused on severely-ill eating disorder patients, it became necessary to diagnose and treat concomitant dissociative disorders. We describe a cognitive-behavioral inpatient program developed and specifically adapted to treat eating disorder patients with dissociative disorders. Patients were identified by self-report measures (the Eating Disorder Inventory and the Dissociative Experiences Scale) and clinical interviews. Specific eating symptoms linked to post-traumatic stress or conversion disorders were approached with stimulus control and hierarchical desensitization. Individual and group cognitive therapy as well as diary techniques addressed irrational beliefs common to both disorders. Skill enhancement through relaxation training, anxiety management, and anger management, initially tailored for the eating disorder patient, required adaptation for dissociative pathology. Addressing both disorders reduced eating pathology whereas inattention to dissociative symptoms led to continued disturbed eating and purging. Identification and treatment of dissociative pathology may improve treatment outcome in the treatment resistant eating disorder patient.Item access-status.open.access.listelement.badge Dissociation : Vol. 7, No. 3, p. 173-177 : The artifactual nature of multiple personality disorder: comments on Charles Barton's "Backstage in Psychiatry: The Multiple Personality Disorder Controversy"(Ridgeview Institute and the International Society for the Study of Dissociation, 1994-09) Merskey, Harold; Barton, CharlesItem access-status.open.access.listelement.badge Dissociation : Vol. 7, No. 3, p. 135-137: Editorial: Ruminations on metamorphoses(Ridgeview Institute and the International Society for the Study of Dissociation, 1994-09) Kluft, Richard P., 1943-Item access-status.open.access.listelement.badge Dissociation : Vol. 7, No. 3, p. 167-172 : Backstage in psychiatry: the multiple personality disorder controversy(Ridgeview Institute and the International Society for the Study of Dissociation, 1994-09) Barton, CharlesHelping professions like psychiatry have traditionally granted their members a wide latitude in diagnosing clients. However, the diagnostic system may be the occasion for professional conflict. Arguments about the existence of Multiple Personality Disorder (MPD) are examples of such a professional dispute. Some mental health professionals report unprofessional conduct both toward professionals making this diagnosis and their patients. Skepticism is manifested in literary as well as behavioral forms. The most widely cited recent skeptical paper is Harold Merskey's (1992) "The Manufacture of Personalities: The Production of Multiple Personality Disorder." Merskey utilizes arguments that are sociological in nature but with little attention to empirical evidence. Merskey's skepticism about MPD differs from skepticism in natural science. Proponents' research is ignored rather than being subjected to critical examination and disproof through attempted replication. His skepticism appears largely based on challenges to the integrity of MPD patients and questions about the competence of therapist.Item access-status.open.access.listelement.badge Dissociation : Vol. 7, No. 3, p. 153-166 : Somatic to psychological symptoms and information transfer from implicit to explicit memory: a controlled case study with predictions from the high risk model of threat perception(Ridgeview Institute and the International Society for the Study of Dissociation, 1994-09) Wickramasekera, Ian E.This is a case study of a patient presenting a variety of somatic symptoms in the absence of any identifiable pathophysiology or psychopathology. Testing with the High Risk Model of Threat Perception (HRMTP), autonomic monitoring and psychophysiological psychotherapy are associated with the retrieval and transfer of unconscious or implicit memories of sexual abuse (independently supported by court records) into explicit or conscious memory. This transfer of "repressed" memory appears to be associated with several powerful and theoretically salient consequences. First, an abrupt correlated remission of multiple somatic symptoms. Second, a correlated large increase in baseline negative affectivity, and third, large correlated changes in involuntary measures of physiological reactivity (e.g., heart rate, EDR, etc.) documented on 4 pre post stress profiles. This inverse relationship between somatic and psychological symptoms plus the marked autonomic shift from a relatively parasympathetically dominant to a highly sympathetically reactive status raises profound theoretical questions regarding the nature and stability of the psychophysiological mechanisms implicated in the transduction of information and memory from physiological to psychological systems. Based on observations in this case study, several experimentally falsifiable predictive hypotheses derived from the HRMTP are presented.Item access-status.open.access.listelement.badge Dissociation : Vol. 7, No. 3, p. 145-152: What is dissociated?(Ridgeview Institute and the International Society for the Study of Dissociation, 1994-09) Sands, Susan H.Our current view of the severe dissociative disorders as trauma-based implies that the dissociated material consists of the traumatic abuse memories, related traumatic affects, etc., and does not adequately address what else is dissociated. It is argued here that chronic, severe trauma also results in the splitting off of the child's healthy, developmental, relational needs and longings. By segregating those needs and longings which are offensive to the child's pathologically-vulnerable caretakers, dissociative defenses serve to maintain and regulate relatedness to others. This expanded view of dissociation suggests that the treatment of severe dissociative disorders must include the remobilization of those early relational need states within the transference relationship and their integration into the patient's central self experience.Item access-status.open.access.listelement.badge Dissociation : Vol. 7, No. 3, p. 138-144 : Obstacles to the recognition of sexual abuse and dissociative disorders in child and adolescent males(Ridgeview Institute and the International Society for the Study of Dissociation, 1994-09) Klein, Hilary; Mann, David R.; Goodwin, Jean, 1946-Previous studies are reviewed which describe difficulties in diagnosing dissociative disorders in general, in children, and in males. Five cases are presented in which males from eight to fourteen years of age were diagnosed as having dissociative disorders after significant delays. In three cases, evaluation did not take place until years after substantiation of child abuse. In one case the child was reabused and in three cases the index victim reabused another child before the dissociative disorder was recognized. Delay in evaluation and diagnosis occurred despite the presence of documented sexual abuse in all cases and typical symptoms including amnestic periods, sudden shifts in behavior and emotion, denial of witnessed behavior, and somnambulistic or trance states. Three patients had at least one first degree relative with a dissociative disorder. Obstacles to recognition included denial of sexual abuse and symptoms by the boys themselves and their families and therapists; other problems included family dysfunction, and the patients' self-isolation. In these cases some qualities of the dissociative systems mitigated against recognition including: 1) the presence of a secret-keeping alter that shielded all victimization memories; and 2) hypermasculine traits in the host including aggressivity and stoicism, which were perceived as hypernormal rather than as resulting from dissociative fragmentation.Item access-status.open.access.listelement.badge Dissociation : Vol. 7, No. 3, p. 000 : Cover, table of contents(Ridgeview Institute and the International Society for the Study of Dissociation, 1994-09)