ISSTD-ESTD Taskforce

Joining forces: The ISSTD-ESTD Taskforce on mainstreaming dissociation in the scientific literature

A core mission of both the International Society for the Study of Trauma and Dissociation (ISSTD) and the European Society for Trauma and Dissociation (ESTD) is the promotion of scientific knowledge about dissociation and dissociative disorders in professional circles and to the public. While there are many professionals who are members of both Societies, or who attend both conferences, the two organisations have operated a bit like somewhat estranged siblings; coming from the same family but having moved in slightly different directions, and perhaps were a little awkward and uncertain of how to deal with the other. Sibling rivalries may have operated where both were concerned about the other’s impact, such as in international conferences, trainings, etc., but underneath these struggles for identity, shared space, mutual independence and growth was the respect, admiration and the mutual connection that comes from kinship. This connection has been recently rekindled with discussions between Martin Dorahy and Andrew Moskowitz leading to the development of a joint Taskforce involving five ESTD members (Andrew Moskowitz, Eli Somer, Simone Reinders, Annemiek van Dijke, and Igor Pietkiewicz) and five ISSTD members (Martin Dorahy, Christa Kruger, Steve Gold, David Gleaves and Vedat Şar). This Taskforce spent the second half of 2016 sharing ideas and discussing issues associated with the central goals of 1) identifying, developing, and formulating the 4-5 most critical questions that need to be addressed at the current time in the field of dissociation, which would 2) further the understanding and education of dissociation and dissociative disorders in the mainstream psychological and psychiatric literatures. A starting agreement was that these questions would be limited to those that could be addressed by conceptual and theoretical developments or by narrative and/or statistical review of existing research studies, rather than being key empirical questions for direct investigation. It is hoped that the most crucial empirical questions for future research studies will emerge from these reviews. The Taskforce traded near-daily emails from the divergent parts of the world that each member resides. Members initially put forward areas (e.g., the psychobiology of dissociation) or questions (e.g., ‘what is the phenomenology of dissociation’?) that they each believed should be discussed with the potential of reflecting upon or being included in the final question summaries. This produced a list of 23 question areas. Efforts were then made to 1) group or merge these, 2) delete any that were not deemed central enough to the field of dissociation and its mainstreaming, and 3) reformulate those that were central but were not framed in a way that drew out the most crucial element/s of the question. Through ongoing discussions, six questions were ultimately formulated that were considered meritorious and deserving attention in terms of the mainstreaming goal. Each of the six questions were then discussed in detail by the whole Taskforce to provide a framework of content that might be covered in the paper. After all were fully discussed and plans were in place for each question, taskforce members divided into working groups that would be responsible for developing each of the questions. Each working group had a designated leader, but all Taskforce members on that group agreed to be responsible for ensuring the paper successfully reached its goal of being published in a mainstream psychology or psychiatry journal. The working groups also determined if other members of ESTD or ISSTD with expertise in the areas of focus could be invited onboard, to complement the working group. The working groups went away to begin work on their specific question in late 2016 with an aim to have first drafts of their paper ready for consideration between the middle to the end of 2017. Following further revisions and editing, including reviewing by the Taskforce, the manuscripts will be submitted to journals. The working titles of the six questions, along with a brief rationale for the reasoning behind their inclusion in this joint ISSTD-ESTD project is now provided.

  1. What is dissociation? Dissociation has often been considered an ill-defined and somewhat ‘slippery’ topic in the psychological literature (e.g., Dell, 2009; Marshall, Spitzer, & Liebowitz, 1999). Papers within the dissociation field have proffered different perspective (e.g., Dalenberg & Paulsen, 2009; Holmes et al., 2005; Kennedy et al., 2004; Steele, Dorahy, Van der Hart, & Nijenhius, 2009), each offering ways to clarify what dissociation is, where it occurs and what psychosomatic manifestations capture it. Dissociation is studied in the trauma and dissociation field, the personality and psychotic disorders fields, and the anxiety disorders (e.g., panic) field. Yet, within the mainstream psychological and clinical literatures dissociation remains ill-understood and not conceptually well defined.

Bringing together the different theories of dissociation, outlining how the term is used in different clinical literatures, and distilling common and unique factors in these different frameworks is likely to bring a greater understanding of what dissociation is and isn’t. In addition, theoretical and methodological considerations will be employed to help determine when it is better to subsume a phenomenon under the same label, and when it is better to consider it a different, but related, phenomenon (such as hypnotisability and absorption, for example). Thus, this paper is designed to examine how dissociation is understood to see if greater clarity can be brought to the concept in order to foster its understanding by those working within and outside the trauma and dissociation field.

  1. Do models of normal and pathological personality structure help us understand dissociative disorders? A core area in mainstream psychology internationally is the study of personality, and a core area in the mainstream study of psychopathology is how personality may form abnormally or become reorganized to produce maladaptive relational patterns and symptoms (e.g., Watkins & Watkins, 1997; Young, Klosko, & Weishaar, 2003) . Very little work has looked at how dissociation theory might be integrated with mainstream personality theory and where the overlapping and divergent areas are.

This question will address two areas. The first area addresses whether empirically demonstrated models of personality, such as the five-factor model (McCrae & Costa, 2003), can inform our understanding of dissociative disorders (that is to say, whether any personality variables or factors predict dissociative disorders). The second area considers the evidence for models of personality that emphasize ‘normal’ parts or divisions (i.e., ego-state theory, dialogical theory; Hermans, 2001) and whether these models can inform our understanding of dissociative disorders. Thus, this paper will set out to examine how dissociation is relevant to the study of personality and how personality theory is relevant to the study of dissociative disorders.

  1. What is the status of recovered memory in the scientific literature? This paper will effectively form a joint position statement from both the ESTD and ISSTD on recovered memory, if the review, conclusions and statement are ratified by the Board of Directors in both organisations. Recovered memory remains somewhat contentious despite the fierce attacks and debates which characterised the memory wars of the 1990s abating somewhat. Notwithstanding its contentious nature in science, in clinical practice it is relatively common for traumatised patients/clients to recall distressing memories they had previously forgotten. It is also now well understood that the memory stimulus induced in the laboratory, no matter how distressing or personally-related, is not a good analogy to study the impact on memory of incestuous abuse, for example. This is not only a highly charged amygdala-based experience, but also involves significant relational betrayal and conflicting attachment needs (e.g., protection by the person causing harm).

Question 3 initially started with a focus on the relationship between dissociation and cognitive processes, like memory and attention, but it became clear that neither Society had a position statement on recovered memory, despite how central dissociation is believed to be to it (e.g., Freyd & Birrell, 2013). Consequently, this question was changed to address recovered memory after the Board of Directors from both Societies voted for this issue to be explored with a view to a joint statement.

  1. Dissociation – intra-individual phenomenon versus collective sociocultural process? Cultural manifestations of dissociation have captured the interest of psychologists, anthropologists, and sociological psychiatrists (e.g., Rhoades & Şar, 2005). Dissociation may underpin intra-personal processes like trauma-related disorders as much as it underpins sociological processes, like mass hysteria, oppressive societies and the denial of child abuse. The link between the individual and the group remains central to psychological science, and to the understanding of war, famine, the impact of greed and empathy on group functioning, and how societies respond to, and in the aftermath of, trauma.

This paper seeks to examine the operation of dissociation at a social and cultural level, exploring where intra-psychic dissociation moves into contagious group dissociation, among other themes. This paper will provide mainstream psychological readers with an appreciation of the importance of dissociation for understanding social processes and group behaviours.

  1. Neurobiology of dissociation, (non-DID) dissociative disorders and DID – non-traumatic versus traumatic etiology? Significant steps have been taken in psychiatric science over the past 20 years to develop an understanding of the neurobiology of a range of psychological illnesses. Advances in imaging technology that allow investigation of the structure and function of the brain when in a stable state or during provocation via activity and stress have been increasingly used in research settings and compliment or advance existing technologies. The study of dissociation and dissociative disorders has been assisted by these advances and by the desire to link neurobiological science to cognitive and behavioural science (Chalavi et al., 2015).

The integration of brain and behavioural sciences has the ability to not only elucidate the psychobiological underpinnings of dissociation and the dissociative disorders, but also direct both psychological and pharmacological therapies. This paper examines the neurobiology of dissociation and the dissociative disorders. Bringing together the extant literature in this developing and fast-growing area will allow the similarities and differences in the neurobiology of dissociative disorders to be compared with other disorders. The pertinence of this question as a central focus in the current project was due to the dominance of neuroscience in mainstream psychiatry and psychology. Greater understanding of the neurobiology of dissociation and the dissociative disorders, and more integration of this knowledge with the neurobiology of other psychiatric illnesses, will allow the dissociative disorders to be understood more clearly in comparison with other disorders, and to become familiar and non-controversial diagnoses in mainstream psychiatric education and practice.

  1. Resistance to dissociative disorders in the scientific literature: Truth, resistance, politics, science and propaganda. Despite having an expanding empirical and clinical knowledge base, dissociative disorders like DID remain controversial. This is despite substantial literature showing their validity as psychiatric entities (e.g., Gleaves, May, & Cardeña, 2001). No empirical study to date, for example, has suggested that the etiology, phenomenology and treatment of DID can be accounted for by another disorder or disorders (e.g., Dorahy et al., 2015). Its complex comorbidity is well attested (e.g., Rodewald et al., 2011). Yet, the mainstream psychiatric and psychological literatures have failed to embrace the reality of dissociative disorders in the same way as other trauma-related disorders or disorders with a similar epidemiological rate in the general population.

Researchers have been largely unsuccessful in getting grants to support large scale, sophisticated studies on dissociative disorders, especially DID, indicating the challenges of integrating dissociative disorders in the mainstream literature. Disorders like DID have appeared to be victim of what is now referred to as ‘post-truth’, where scientific knowledge is ignored over emotional and personal beliefs. DID, for example, asks that we accept the reality of extreme child abuse where caregivers use children in their care for their physical, sexual or emotional gratification, or in which they fail to offer adequate care and protection. This reality in and of itself seems less of an issue than accepting that such abuse and neglect is quite common rather than quite rare. In addition, DID requires us to accept that our sense of self can divide to the point that behaviour seemingly occurs outside awareness and control. This comes as a real challenge to the Western individualist cultural norms of a unified mind and self-control. Understanding barriers to the resistance of dissociative disorders in the world of psychological science, and the truth, post-truth, politics and propaganda associated with them, has the potential to help overcome the current challenges in getting dissociative disorders in the mainstream psychological and clinical literatures. Members of the joint Taskforce who are able to attend will meet in person at the 2017 conferences of the ISSTD (March, Washington, DC) and the ESTD (November, Bern). Both opportunities will allow an update on progress and challenges blocking progress. The Taskforce will feedback to the memberships of ESTD and ISSTD as tangible progress is made on these projects. 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