Trauma-related sexual symptoms are common following interpersonal trauma yet are rarely systematically addressed in trauma-focused treatment. This multicenter pilot study aimed to evaluate the safety, applicability, and preliminary efficacy of a novel manualized group intervention integrating trauma-specific and sex therapy techniques (TrusT). In a multicenter pilot study, 54 individuals assigned female at birth (51 female, 3 non-binary, mean age = 33.8) with a history of interpersonal trauma and persistent sexual symptoms participated in a 12-week group therapy program with weekly sessions. Baseline, post-treatment, and three-month follow-up data were analyzed. The intervention led to significant improvements in trauma-related sexual symptoms (p < .001), posttraumatic stress disorder (PTSD) severity (p < .001), and dissociative symptoms during sexual situations (all p < .05) after treatment, with sustained effects at follow-up and large effect sizes. Additionally, participants reported enhanced self-determined sexuality (all p < .05), while reported side effects remained minimal. TrusT appears to be a safe and well-tolerated intervention with encouraging preliminary effects on trauma-related sexual symptoms in a clinically underserved population. Further research, including randomized controlled trials, is necessary to confirm efficacy and inform integration into trauma-focused treatment frameworks.
Autism spectrum disorder (ASD) is associated with a variety of mental health conditions, including dissociation. In addition to high rates of trauma exposure, vulnerability for dissociation in autism may be heightened by social differences, cognitive inflexibility, and sensory sensitivities. This study examined dissociative symptoms across levels of autistic traits using existing clinical data from 716 individuals receiving mental health care ("clients") in Australia. Clients completed the Multidimensional Inventory of Dissociation-60 (MID-60), the Ritvo Autism Asperger Diagnostic Scale-Revised (RAADS-R), and the Adverse Childhood Experiences Questionnaire (ACE-Q) or Life Events Checklist for DSM-5 (LEC-5). Clients were grouped according to their RAADS-R scores, measuring autistic traits. Analyses first compared those with high autistic traits (HA; ≥120; n = 338) to below-threshold autistic traits (BA; <120; n = 378). The latter group was then subdivided into those with moderate autistic traits (MA; 65-119; n = 214) and low autistic traits (LA; <65; n = 164) for more comprehensive analysis. HA clients had the highest scores on all trauma and dissociation measures and subscales, and clinically elevated dissociation was significantly more prevalent among HA clients (68%) than BA clients (33%; OR = 4.42) and LA clients (15%; OR = 12.59). MA clients also scored higher than LA clients in almost all domains. Autistic traits and dissociation severity were significantly correlated overall and for all subscales, with the strongest correlations found for the RAADS-R Sensory-Motor domain. All relationships remained significant after controlling for ACEs. This highlights the need for routine screening and tailored interventions addressing both autistic traits and dissociation.
First responders are routinely exposed to trauma, elevating risk for post-traumatic stress disorder (PTSD) and related psychological difficulties. Personality traits influence adjustment through appraisals, emotion regulation, attachment, and social support; however, their role in this population is understudied. A sample of 341 Portuguese first responders (80.1% male; mean age = 34.2) completed measures of Big Five traits, PTSD symptoms, distress, attachment, social support, and emotion regulation. Latent profile analysis identified four profiles. One, marked by high neuroticism and low conscientiousness, extraversion, and agreeableness, showed greater PTSD (23.1%), distress, anxious attachment, poor regulation, and reduced support. Profiles with lower neuroticism and higher adaptive traits showed fewer trauma symptoms and stronger resources. Findings support the use of personality-informed prevention and tailored interventions.
The link between traumatic events, such as sexual abuse, and dissociation is well-documented, but the mechanisms underlying these symptoms remain unclear. The aim of this study was to investigate the relationship between sexually abused individuals' dissociative experiences and emotion dysregulation and mindfulness; and to examine whether mindfulness and emotion dysregulation play a role in the relationship between sexual abuse and dissociative symptoms. The sample consisted of 52 female adolescents who were victims of sexual abuse and 52 female adolescents without a history of sexual abuse who attended the child psychiatry clinic. All participants were asked to fill out the Adolescent Dissociative Experiences Scale (ADES), the Mindful Attention Awareness Scale (MAAS) and the Difficulty in Emotion Regulation Scale Brief Form (DERS-16). Findings revealed that dissociative symptoms and emotion dysregulation were significantly higher, and mindfulness was lower in the abused group. Both mindfulness and emotion dysregulation were found to mediate the relationship between sexual abuse and dissociative symptoms. In a literature review conducted by the researchers, no study in a clinical setting was found in which the role of mindfulness and emotion regulation in the relationship between sexual abuse and dissociation in adolescents exposed to sexual abuse was examined together. We believe that our results are unique and furthermore it is believed that considering and developing mindfulness and emotion regulation in the treatment process of sexual abuse victims will be beneficial for patients.
Mental health practitioners assess and treat trauma and dissociation by considering the biopsychosocial factors influencing the symptomatology of clients. In this process, clinicians often default to a prescriptive model that inherently assigns generalized cultural values to certain marginalized groups. Particularly for Latines, clinicians may overaccentuate the cultural value of familismo, the centering of family, for all Latine clients. These cultural values often translate into clinicians' expectations that their Latine clients will cherish their familial relationships in ways that make familismo an asset in treatment. However, for multiply marginalized Latines who endure intersectionality, familismo may not only be a detriment to trauma treatment, but the source of psychological distress itself. In this theoretical article, we center sexual and gender minoritized (SGM) Latines as we reconceptualize familismo as a potentially oppressive cultural value that may additionally be a contributing structural factor to both betrayal trauma exposure and dissociation by way of double-consciousness (du Bois, 1903). We define and briefly review the literature on familismo, intersectionality, and secondary marginalization. We also describe how intersectionality may contribute to dissociation and resistance through the framework of double-consciousness. We use a hypothetical case example to demonstrate the role of double-consciousness in dissociative responses to betrayal and discuss the implications for clinical practice and research.
This theoretical article centers dissociative fragmentation - a trauma-informed construct drawn from dissociation research - to explain the psychological costs faced by marginalized elites: individuals who attain high-status positions while belonging to historically oppressed groups. Unlike cognitive dissonance, which accounts for episodic tensions, dissociative fragmentation captures the chronic partitioning of identity required to survive conformity-driven elite environments. Marginalized elites are defined with demographic and occupational examples, situating their paradoxical position of authority and exclusion within structures of racism, sexism, heteronormativity, ableism, and classism. The analysis builds on intersectionality and racial trauma literature. Insights from psychology, sociology, and Black feminist thought are synthesized to construct a unified framework. Impostor phenomenon, stereotype threat, and intersectional invisibility are integrated as proximal states within a process model that culminates in identity fragmentation. The framework clarifies how institutional feeling rules, tokenization, and microaggressions foster chronic compartmentalization of self, leading to alienation, burnout, and trauma-like symptoms. Institutional remedies are also proposed - including identity-safety cues, sponsorship structures, intersectional norms change, and healing-centered engagement - that shift responsibility from individuals to organizations. By reframing conformity's toll as structurally induced dissociation, this article advances a trauma-informed, intersectional agenda for research and practice that centers justice alongside psychological well-being.
Dissociation can be regarded as a normal and complex set of mental phenomena that may operate within multiple conditions. This Institutional Review Board approved study examined a group of pre-professional/professional performing artists and college athletes (N = 687) and explored ethnic group differences in multidimensional symptoms of dissociation and shame, as well as cumulative trauma exposure, within four major ethnic groups: Black (14%), Asian (21%), White (43%), and Latinx (22%). The measures included a brief health and demographic screener, the Multiscale Dissociation Inventory, the Internalized Shame Scale, Adverse Childhood Experience Questionnaire, and Traumatic Event Questionnaire. Findings in these exploratory analyses included significant ethnic group differences for cumulative trauma, three shame dimensions, and five dissociation dimensions. The four groups had different prevalence rates for specific trauma types (childhood adversity, non-sexual/sexual assault by stranger or known person, serious life-threatening illness/injury), with the Black group experiencing higher prevalence rates for victim of violent crime, childhood physical abuse, parental separation, and family member incarcerated. The Latinx group had less shame dimensions and dissociative symptoms compared to the other three groups. In general, the Latinx group seemed to exhibit more resilience and less psychological distress compared to the Black, Asian, and White groups. Fragile shame was a predictor of general dissociation for all four ethnic groups. Empty/alone shame significantly predicted general dissociation for the Asian, White, and Latinx groups. Cumulative trauma predicted general dissociation for the Black and White groups. The need to examine intersectionality, inequity, trauma, and dissociation remains essential.
BACKGROUND:Childhood sexual abuse (CSA) is associated with significant psychiatric morbidity and has been reported at notable rates among Jewish Israeli women. Yet data regarding abuse characteristics, psychiatric history and longitudinal treatment outcomes in this population are lacking. OBJECTIVE:We assessed abuse experiences, clinical profiles and psychiatric histories of adult Jewish women CSA survivors and evaluated the effectiveness of designated psychotherapy over one year. PARTICIPANTS AND SETTING:A clinical sample of women CSA survivors (N = 122) were treated in weekly psychotherapy in public specialized outpatient centers in Israel. METHODS:Patients self-reported on Childhood Maltreatment (CM), posttraumatic stress disorder (PTSD) symptoms, dissociation, borderline personality (BPD) traits, and psychological well-being at treatment onset (T1), after six months (T2), and after one year of therapy (T3). CSA characteristics and psychiatric history were assessed by a semi-structured clinical interview at T1. RESULTS:Most (85.3%) patients reported prolonged CSA histories, with 71.3% reporting intrafamilial abuse. At T1, 7.5% reported currently being abused and 8.3% were currently living with the abuser. Higher levels of CM were significantly associated with higher PTSD, dissociative and BPD symptoms and lower psychological well-being at T1. CM was significantly associated with suicide attempts, psychiatric hospitalizations and psychiatric medication use at T1. Specifically, nearly all individuals with these clinical histories reported moderate to extreme CM. Over the course of treatment (T1 to T3), PTSD symptoms significantly decreased and dissociative symptoms showed reductions from baseline to the one-year assessment, although the overall time effect approached statistical significance. Psychological well-being demonstrated a positive trend throughout the treatment year, with significant improvements observed between baseline and the one-year follow-up, while BPD traits did not change. CONCLUSIONS:These findings underscore the complex clinical needs of CSA survivors and demonstrate that specialized, long-term psychotherapy effectively reduces core trauma symptoms while fostering significant gains in psychological well-being.
The aim of the present study was to verify the reliability and validity of the Italian Multidimensional Inventory of Dissociation (I-MID) when applied to a clinical sample. The I-MID was administered to 100 outpatients presenting to a south-Italian public psychology service for psychotherapeutic treatment. Both self-report and interview-based methods were used to assess traumatic experiences and dissociative symptoms. The Dissociative Disorders Interview Schedule DSM-5 Version (DDIS-5) was utilized to identify dissociative disorders and psychiatric diagnoses commonly associated with dissociative and symptoms and disorders. The I-MID showed strong internal consistency, structural, convergent, and construct validity. Results addressing temporal stability were good for the MID mean score, but results for the different scales were more variable across time. Discriminant validity was good, but some limitations imposed by the clinical sample prevented a sound evaluation of this test property. Information about construct and discriminant validity for the Italian versions of the Dissociative Experiences Scale-II (DES-II) and the Dissociative Symptom Scale (DSS) is also provided. All instruments exhibited good psychometric properties. However, the I-MID showed better incremental validity compared to the DES-II, and provided some evidence of enhanced discriminant validity relative to both the DES-II and DSS. The findings of this study support the validity of the MID and its underlying subjective-phenomenological model of dissociation in an Italian clinical sample. Finally, the prevalence of dissociative disorders in our outpatient sample aligned with findings from other countries' epidemiological studies.
Secondary Traumatic Stress (STS) presents considerable emotional and psychological hazards to psychotherapists continually exposed to clients' trauma histories. While quantitative research has demonstrated an overlap between STS and post-traumatic stress disorder (PTSD), qualitative studies have not explicitly examined the extent to which psychotherapists' lived accounts align with the four PTSD clusters delineated in DSM-5. Using constructivist grounded theory and in-depth interviews with 16 psychotherapists from diverse clinical settings, this study found that therapists' experiences mirrored DSM-5 categories of intrusions, avoidance, alterations in arousal/reactivity, and alterations in cognition and mood. The findings also revealed additional domains, including moral distress, professional silencing, and cumulative emotional burden. The findings position STS as a multifaceted, embodied, and ethically complex phenomenon that necessitates a multilayered approach to intervention including trauma-informed supervision, reflective training, and organizational practices responsive to the cumulative toll of trauma work.
The Treatment of Patients with Dissociative Disorders (TOP DD) Network Study offered psychoeducation and exercises to help patients with complex trauma-related dissociation and their therapists learn how to reduce symptoms and increase adaptive capacities. This paper examines whether 227 dissociative disorder (DD) patients' engagement with TOP DD Network Study program exercises was associated with improvements in coping skill use, symptom severity, and adaptive functioning. Multilevel modeling techniques revealed that more engagement in written and practice exercises than usual for participants was associated with greater coping skill use across weeks in the study when controlling for time. Further, to the extent that participants reported more coping skill use than was typical for them, their mental health symptoms and dissociative symptoms decreased at a faster rate than would be expected as a function of time. More than usual use of coping skills was also associated with increased self-kindness and adaptive functioning, controlling for time. Finally, a Monte Carlo method for assessing mediation revealed that more engagement with the program's exercises was linked with improved treatment outcomes through their association with greater than average use of coping skills, controlling for weeks spent in the study. Completion of relevant written and practice exercises appears useful in encouraging coping skill use for individuals with dissociative disorders. Further, results suggest that the educational components of the TOP DD Network Study contributed to participants' ability to reduce symptoms, increase self-kindness, and develop adaptive capacities.
Dissociation has increasingly been acknowledged as a key factor in post-traumatic stress disorder (PTSD) and complex PTSD (CPTSD). However, there is evidence that it is not being recognized by clinicians and often trauma treatments do not target dissociation experiences. The purpose of this review was to investigate the effect of any psychological intervention compared to any control on dissociation in adults with PTSD and/or CPTSD. Systematic database searches (PsychINFO, COCHRANE, EMBASE and Medline) were conducted using a predetermined search strategy and inclusion criteria to identify controlled trials reporting psychological therapies for trauma, had a control group and measured dissociation as an outcome. To assess the risk of bias in studies, the Risk of Bias 2 (ROB-2) tool and the Mixed methods appraisal tool (MMAT) were used. Thirteen studies were included in the review. Using a random effect model to perform the meta-analysis, a small effect of current treatments on dissociation experiences was found (g = -0.28, 95% CI [-0.41, -0.15]; Z = -4.12, p < .001), with a small level of heterogeneity across studies (I2 = 7.8%). Subgroup analyses showed some important effects across control conditions, therapy modalities and type of measures, albeit overall moderation was not significant in any of the models. While the overall treatment effect was observed when dissociation was a secondary outcome in most studies, for PTSD treatments to be effective on dissociation interventions they need to focus on dissociation more explicitly.
Thousands of Veterans file military sexual trauma (MST)-related PTSD disability claims annually through Department of Veterans Affairs (VA) for broadly covered healthcare benefits and monthly compensation. Although MST-related claims have been subject to much governmental reporting and oversight, no study has examined the perspectives or experiences of Veterans filing MST-related disability claims, including potential associations with institutional betrayal (i.e. wrongdoings perpetrated by an institution upon individuals dependent on that institution). Between March-October 2024, we interviewed 15 Veterans who recently filed MST claims. Data were analyzed inductively through thematic analysis. Most participants described MST-related claims process components that were retraumatizing, such as having to "relive" their MST experience through repeated telling of their MST across multiple individuals (e.g. therapists, disability evaluators, via the claim form). These experiences were retraumatizing even for individuals with a positive perception of those involved in evaluating their claims. Participants described feelings of invalidation through perceptions of needing to be a "perfect victim" and that their claim was impacted by aspects of their identity (e.g. race) or pre-military trauma. For some, being awarded MST-related disability was seen as validating. For others, retraumatization and invalidation contributed to perceptions of VA-enacted institutional betrayal, which impacted their trust in and likelihood of using VA healthcare. Veteran participants' experiences with the MST claims process extend prior work on institutional betrayal among MST survivors. These findings underscore the need for additional support during the MST claims process, such as increased information and expectation-setting ahead of claim filing and disability evaluations.
This case study describes the psychotherapeutic process of one man, Francesco, whose compulsive same-sex sexual behavior was found to be driven by an underlying dissociative state. Francesco's therapy experience draws attention to the psychodynamics and intersectional oppressions that may influence outcomes related to the experiences of childhood trauma, subsequent dissociation, traditional religion, and same-sex sexuality. Although treatment trajectories are unique to each person, Francesco's psychotherapy experience suggests the contribution of dissociation to sexual compulsivity can be reduced by bolstering new affect regulation strategies, attending to locus of control dynamics, and promoting a more secure attachment base both intrapsychically and, initially, within the therapy relationship.
Survivors of abuse, such as intimate partner violence (IPV), may experience a range of mental health difficulties. A new theory introduces a harmful and often overlooked aspect of abuse: doubt regarding abuse-related appraisals (DARA). This concept refers to survivors' uncertainty about their assessments of the abuse, their own experiences during the abuse, and their perpetrator. According to this view, DARA not only deepens survivors' confusion but also hinders the healing process, increasing their vulnerability to trauma-related symptoms. This study aimed to explore these ideas by examining (1) the relationships between DARA and trauma-related symptoms following IPV, and (2) the contribution of DARA in explaining trauma-related symptoms beyond childhood abuse history, degree of IPV exposure, length of the abusive relationship, and IPV status. An online survey was conducted among a convenience sample of female adults. The sample consisted of 378 women aged 19-60 years (M = 35.50, SD = 8.64) who reported experiencing IPV and provided data on the study variables. Trauma-related symptoms, DARA, childhood abuse history, and IPV characteristics (degree of IPV exposure, length of the abusive relationship, and IPV status) were assessed through self-report measures. The results revealed significant associations between DARA and trauma-related symptoms. Furthermore, analyses indicated that DARA uniquely explained trauma-related symptoms beyond childhood abuse history, degree of IPV exposure, length of the abusive relationship, and IPV status. The current findings support the DARA theory and highlight the need for clinical interventions aimed at reducing DARA to alleviate trauma-related distress in survivors.
Dissociative identity disorder (DID) is a childhood-onset posttraumatic biopsychosocial syndrome characterized by identity alteration symptoms in which one loses a sense of agency and ownership over some thoughts, feelings, memories, and behaviors. There is limited investigation of sociodemographic variability related to DID prevalence. Further, there is limited assessment of symptoms in non-clinical samples that may shed light on potential dissociative phenotypes in the general population. We utilized a large citizen science online data collection platform to collect self-report symptoms of dissociative identity disorder among self-selected adults in the general population. Participants (N = 5,589) provided demographic information and completed the Multiscale Dissociation Inventory self-report assessment (MDI). We completed general linear models to investigate associations between race, gender, and geographic location with a provisional self-report DID diagnosis and MDI identity dissociation scores. In general, individuals from marginalized racial groups had higher provisional DID prevalence rates and more severe identity dissociation symptoms compared to White individuals. Genderqueer individuals reported higher rates of provisional DID compared to men and women, and men reported higher rates compared to women. We also observed significant differences in the prevalence of DID symptoms across geographic regions. These novel results suggest that race, gender, and geographic location are linked to variation in rates of provisional DID diagnosis and identity alteration symptom severity. Marginalized groups with potentially the highest rates of DID are underrepresented in current research. Future work should explore contributing factors to these sociodemographic differences to develop effective prevention and treatment strategies for specific groups.
