Journal of Trauma & Dissociation
March 20, 2014
Paul Frewen, Ruth A. Lanius
59 citations
A 4-D model classifies posttraumatic stress symptoms into those occurring in normal waking consciousness versus those representing dissociative altered states of consciousness. Across four dimensions—time-memory, thought, body, and emotion—the model predicts that dissociative symptoms are less frequent, less intercorrelated as momentary states, more common in people with high dissociative symptoms, and more frequent after repeated trauma, especially early developmental trauma. In a sample of 74 women with PTSD primarily from childhood trauma and 504 undergraduates, the first two predictions were supported; the third held in the PTSD sample. However, childhood trauma severity was not strongly linked to dissociative symptoms, indicating further research is needed.
Journal of Trauma & Dissociation
September 17, 2020
Everton de Oliveira Maraldi, A. Costa, Alexandre Cunha et al.
13 citations
Pathological possession experiences, defined as involuntary and unwanted alterations of consciousness attributed to spiritual forces, were subsumed under dissociative identity disorder (DID) in DSM-5, but this link is contested by researchers across countries. It remains unclear how pathological possession differs from possession delusions in psychosis or from cultural syndromes such as ataque de nervios, which some authors consider dissociative. Nonpathological dissociative experiences, including spiritual experiences during religious or ritualistic practices, are also poorly understood.
Journal of Trauma & Dissociation
April 7, 2025
Sarah K. Danböck, Yoki L. Mertens, Patricia Kulla et al.
3 citations
Dissociative symptoms—such as depersonalization, derealization, or gaps in awareness—occur across many mental disorders, not only dissociative disorders but also posttraumatic stress disorder and borderline personality disorder, where they significantly impair wellbeing and functioning. Despite extensive research, empirical findings on neurobiological correlates and treatment-outcome effects remain inconsistent, partly due to methodological heterogeneity and limitations. This critical review evaluates current methods for assessing and provoking dissociative symptoms in the laboratory, selecting participant samples, and considering key sample characteristics. It discusses the strengths and limits of standard and novel approaches, aiming to raise and harmonize research standards and guide future studies toward a better understanding of dissociative psychopathology.
Journal of Trauma & Dissociation
August 2, 2025
P. G. Rossini, F. Malandrone, Mariagrazia Merola et al.
The Italian version of the Multiscale Dissociation Inventory (MDI-ITA) is a reliable and valid tool for measuring dissociative experiences in Italian-speaking adults. In a sample of 439 participants, the inventory showed strong internal consistency, with Cronbach's alpha above 0.71 for each subscale, and high test-retest reliability (correlation of 0.91). The five-factor structure—Disengagement, Depersonalization/Derealization, Emotional Constriction, Memory Disturbance, and Identity Dissociation—was confirmed. The MDI-ITA correlated well with other dissociation measures and showed weaker correlations with depression, anxiety, and post-traumatic symptoms, supporting its convergent and discriminant validity. This tool can be used in clinical and research settings to assess dissociation comprehensively.
Journal of Trauma & Dissociation
July 4, 2023
A. Vancappel, C. Hingray, C. Réveillère et al.
Mindfulness abilities are linked to dissociation in people with PTSD, and the relationship is mediated by emotional non-acceptance and attentional difficulties. In a sample of 90 patients with PTSD, those with more severe dissociative symptoms reported lower mindfulness capacity. Statistical analysis showed that mindfulness indirectly reduced dissociation through improved emotional acceptance and attention, supporting a model where these two components are active mechanisms of mindfulness. The findings suggest mindfulness-based interventions might help treat dissociation, but clinical trials are needed to confirm causality.
Journal of Trauma & Dissociation
April 15, 2022
D. Simeon, Frank Putnam
About 4.1% of U.S. adults meet criteria for pathological dissociation likely indicating a dissociative disorder. People with pathological dissociation have worse physical and mental health, high rates of most major psychiatric disorders, and are often hospitalized for psychiatric reasons. Over half have attempted suicide—significantly more than those with lifetime major depression. Childhood maltreatment—including physical abuse, witnessing domestic violence, physical neglect, emotional abuse, and emotional neglect—each uniquely and additively predicts the severity of pathological dissociation and its three core experiences: amnesia, depersonalization/derealization, and identity alteration. Maltreatment levels in the pathological dissociation group exceed those in major depression and match those in PTSD, underscoring the need for better diagnosis and treatment of these common and debilitating conditions.
Journal of Trauma & Dissociation
September 17, 2015
Nicole C A Tzannidakis, P. Frewen
People with posttraumatic stress disorder (PTSD) often experience symptoms tied to normal waking consciousness (NWC-distress) and trauma-related altered states of consciousness (TRASC). This study examined how these two symptom types relate to social and occupational problems. Both NWC-distress and TRASC independently predicted self-reported interpersonal and work difficulties. However, individuals attributed their social and work problems more strongly to NWC-distress than to TRASC. The findings suggest that dissociative symptoms may be perceived as less disruptive to daily functioning than other PTSD symptoms, pointing to potential targets for clinical assessment and intervention.
Journal of Trauma & Dissociation
September 17, 2015
P. Frewen, K. Hegadoren, N. Coupland et al.
A theoretical 4-D model distinguishes posttraumatic stress symptoms that occur in normal waking consciousness (NWC) from those that involve dissociative experiences, called trauma-related altered states of consciousness (TRASC). This prospective study of 180 people assessed in emergency departments after traumatic events found that both TRASC and NWC-distress symptoms measured at 6 weeks independently predicted social and occupational impairment at 12 weeks. The results largely supported the 4-D model, but contrary to hypotheses, childhood trauma history correlated more strongly with NWC-distress than with TRASC symptoms.