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Chapter 4 analyzes the psychological and physical effects of slavery. Here, it is argued that we continue to place trauma within existing psychological frameworks but fail to understand the effect of ownership and objectification, which presents unique challenges to survivors of slavery and has ramifications for the support structures that are put in place. The chapter argues that the need to bear witness, on both the part of the listener and the narrator, is crucial to meaningful growth in the light of current ill-suited support and allows an acknowledgment of the truth of survivors’ lives. This chapter in particular draws on autobiographies and my own interviews with survivors, mapping their journeys and experiences to the psychological literature on trauma, and exploring the need to bear witness as a powerful means of growth
The current study tests the relationship between eating disorder (ED) symptoms and trauma exposure. The mechanisms via which trauma is related to ED symptoms have not been sufficiently examined. This study examines the complex role of dissociation and emotional dysregulation in the context of trauma, BMI, ED symptoms and body dissatisfaction (BD).
We hypothesized that dissociation and emotional dysregulation would mediate the relationship between trauma exposure and ED symptoms / BD. We further hypothesized that BMI would play a moderating role in this association.
A community sample of 229 (16.2% male) participants, with a mean age of 29.08±10.68 reported online on traumatic events (Life Events Checklist), dissociation (Dissociative Experiences Scale – II), emotional dysregulation (Difficulties in Emotional Regulation Scale), ED symptoms (Eating Disorders Examination – Questionnaire) and BD (Figure Rating Scale).
Participants reported experiencing a mean of 2.87±2.27 traumatic events, with a relatively high percentage (˜86%) reporting at least one. The most commonly reported traumatic events were transportation accidents and physical assault. Although frequency of traumatic events did not directly predict ED symptoms, BMI, dissociation, emotional dysregulation and BD did. An SEM model showed that traumatic events predicted ED symptoms indirectly through dissociation, emotional dysregulation and BMI. Dissociation and emotional dysregulation predicted ED symptoms directly. BMI also moderated the association between traumatic events and both ED symptoms and BD.
Therapists treating patients with high BMI or obesity should be aware of these relationships and investigate the possibility that trauma and/or PTSD may underlie the presenting disordered eating or eating disorder.
An established body of literature has identified that PTSD and dissociation are comorbid. Furthermore, the DSM introduced a dissociative subtype of PTSD into their most recent update; DSM-5.
The current study aimed to examine symptom-level associations between PTSD and dissociation using network analysis among UK Armed Forces veterans resident in Northern Ireland (NI) to identify if there are certain symptoms that may act as bridges between the two constructs.
A large scale cross sectional survey was conducted examining the physical and mental wellbeing of UK Armed Forces Veterans living in NI. The total eligible sample size was 619 (89.8% male), with a mean age of 55.38 years (SD = 10.41). Two networks were estimated, (1) a network consisting of 20 DSM-5 PTSD items and (2) a network consisting of 20 PTSD items and four dissociative items. Expected influence bridge centrality was calculated to examine symptoms with the most/strongest cross-domain associations (i.e. between PTSD and dissociation). The presence of meaningful clustering among symptoms was also explored.
The PTSD symptoms ‘concentration problems’, ‘flashbacks’ and ‘negative emotional state’ had the highest relative bridge expected influence centrality. Of the four dissociative items, ‘gaps in awareness’ had the highest relative bridge expected influence centrality, followed by ‘cognitive-behavioural re-experiencing’. A community structure of five clusters was detected. Four clusters reflected each subscale of the PCL-5 PTSD items and the final cluster reflected the dissociation items.
This study extends our understanding of PTSD and disociation comorbidity by investigating symptom level relationships; potentially informing future treatments and interventions.
Patients with “personality disorder”, has history of traumatic life events and are predisposed to develop alexithymia and dissociation, considered as risk factor for severity.
The aim of the research is to analyze alexithymia relating to dissociative symptoms, and investigate their associations, in 34 patients with personality disorder.
Outpatients with personality disorder relating to Mental Health Centre have been identified and tested with the Dissociative Experiences Scale, the Parma Scale for Personality Functioning and the Toronto Alexithymia Scale.
There was no significant association between age of patients and presence of alexithymia (r=-0.16) and dissociation (r=-0.19); most patients with alexithymia and dissociation were female (67%; 0.67%). 71% of alexithymic subjects had attended lower secondary school, 50% upper secondary school and 43% had a university degree. Substance use is higher in alexithymic patients (73%). 69% of subjects who do not undergo any individual or group psychotherapy are alexithymic; for dissociative symptoms it is significant to undergo both psychotherapies. Alexithymia and dissociation are more frequent in histrionic personality disorder (80%; 60%) and borderline personality disorder (55%; 54%). There is a potential correlation between alexithymia and the presence of dissociative symptoms (r=0.64).
This study found that alexithymia and dissociative symptoms are frequent within personality disorders, particularly in histrionic and borderline personality disorder. We found that the two phenomena were associated. Furthermore we found alexithymia is more influenced by external factors than dissociative symptoms.
The authors outline areas that need special attention. The purpose of the appointment should be explained, and the practicalities of attendance addressed. The attitude/approach of the clinician is discussed in relation to creating a sense of safety and trust. Individuals may fear authority and may have had experiences they find difficult to disclose.
Confidentiality, safety and anxieties about the assessment are reviewed, as people may have little prior knowledge of the system and have had bad past experiences. Acknowledgement and discussion are crucial. More detailed discussion of working with interpreters follows, as this is an often-neglected area. Pros and cons of ‘remote working’ are reviewed.
Some specific aspects of assessment are considered: difficulties in disclosure and how to explore issues such as torture, sexual violence, domestic abuse, moral injury, and rape.
People seeking asylum may be isolated with few resources. Strengths should be emphasised, and sources of support identified, and contact facilitated. Feedback and checking understanding are helpful, and often fosters trust. Scrupulous record keeping is emphasised.
Starting from a cognitive point of view, this paper provides an entirely new reading of the dances and chants of the Salian priests. By focusing on their dances and chants in the perspective of embodied cognition and by putting a diligent analysis of (a) the reports and (b) the prayer texts into historical comparisons with other ‘prophetic’ practices of that time, this study is able to elucidate the Salian performances as body techniques that go beyond a mere facilitation of sociality. These techniques alter the practitioners’ states of mind and thereby elicit an experience that one may call religious experience, divine experience, or ‘possession’.
Visual experiences such as hallucinations are commonly reported by people with psychosis, psychological trauma and dissociative states, although questions remain about their similarities and differences. For diagnostic and therapeutic purposes, clinical research must better delineate and compare the characteristics of these experiences in post-traumatic stress disorder (PTSD) and in schizophrenia.
To compare visual phenomena and dissociation in participants with a primary psychotic illness and those with a trauma diagnosis.
A quantitative group design study comparing visual phenomena in three participant groups who also have a history of hearing voices: schizophrenia and no trauma history (n = 19), PTSD with dissociation (n = 17) and comorbid schizophrenia and PTSD (n = 20). Validated clinical measures included the North-East Visual Hallucination Interview, PTSD Symptoms Scale Interview, Clinician Administered Dissociative States Scale, Psychotic Symptoms Rating Scales and Positive and Negative Syndrome Scale.
There was a remarkable similarity in visual experiences, including rates of complex visual hallucinations, between the three diagnostic groups. There were no significant differences in the severity or components of distress surrounding the visual experiences. Dissociation predicted visual hallucination severity for the comorbid schizophrenia and PTSD group, but not for PTSD or schizophrenia alone.
Visual experiences in PTSD can include visual hallucinations that are indistinguishable from those experienced in schizophrenia. Multimodal hallucinations are frequently observed in both schizophrenia and PTSD. A model for visual hallucinations in PTSD is suggested, following two separate neurobiological pathways based on distinct responses to trauma.
Current neurobiological models of post-traumatic stress disorder (PTSD) assume excessive medial frontal activation and hypoactivation of cortico-limbic regions as neural markers of post-traumatic dissociation. Script-driven imagery is an established experimental paradigm that is used to study acute dissociative reactions during trauma exposure. However, there is a scarcity of experimental research investigating neural markers of dissociation; findings from existing script-driven neuroimaging studies are inconsistent and based on small sample sizes.
The current aim was to identify the neural correlates of acute post-traumatic dissociation by employing the script-driven imagery paradigm in combination with functional magnetic resonance imaging.
Functional neuroimaging data was acquired in 51 female patients with PTSD with a history of interpersonal childhood trauma. Blood-oxygen-level-dependent response during the traumatic (versus neutral) autobiographical memory recall was analysed, and the derived activation clusters were correlated with dissociation measures.
During trauma recall, enhanced activation in the cerebellum, occipital gyri, supramarginal gyrus and amygdala was identified. None of the derived clusters correlated significantly with dissociative symptoms, although patients reported increased levels of acute dissociation following the paradigm.
The present study is one of the largest functional magnetic resonance imaging investigations of dissociative neural biomarkers in patients with PTSD undergoing experimentally induced trauma confrontation to elicit symptom-specific brain reactivity. In light of the current reproducibility crisis prominent in neuroimaging research owing to costly and time-consuming data acquisition, the current (null) findings highlight the difficulty of extracting reliable neurobiological biomarkers for complex subjective experiences such as dissociation.
Empathy and dissociation form a paradoxical and dynamic fusion of opposites in the creative trance. Inherently structured by its domain, cultural traditions, personal preferences, and rules to achieve excellence, the creative trance is an experience of empathy connecting the creative person with the work produced, while dissociation separates the trance state from waking consciousness. Empathy can enhance sports performance by intuiting the moves of an opponent. Stanislavski’s system of empathic acting revolutionized film and theater, and in science, Alexander Graham Bell felt he became one with his machines. Some empathic people view creativity as their children; Charles Dickens called David Copperfield his “favorite child.” Dissociative inspiration can seem to originate from a Muse or divine source; Giacomo Puccini believed his opera Madame Butterfly “was dictated to me by God.” Cross culturally, dissociation in ritual trance possession where dancers assume the identity of deities, may bring numinous experiences for both performers and audiences.
The aims of this study were: (a) to examine associations of oxytocin receptor gene (OXTR) single nucleotide polymorphisms (SNPs) with post-traumatic stress disorder (PTSD) and dissociative symptoms and (b) to investigate gene–environment (G × E) interaction with childhood maltreatment. Salivary DNA samples from 228 women of European ancestry were analysed. Two SNPs, rs237895 and rs237897, were associated with dissociative symptoms but not PTSD diagnosis. Another SNP (rs2254298) was associated with dissociation when interacting with history of childhood maltreatment. These results contribute to theorising and evidence suggesting that the oxytocin system and its genetics may be associated with risk for dissociation among European American women, including those with maltreatment history. Replication with larger patient samples, including men and other ancestry groups, is needed.
Some cases of sexual serial killing exemplify anger directed at an ex-wife/partner, which gets transferred to other women. These involve (1) displaced aggression and (2) collective guilt of women as a whole, or particular types of women, such as sex workers. Faryion Wardrip exemplifies anger directed towards his ex-wife, and he reported seeing her face as he was killing. The killings appeared to be unplanned. Russian police officer Mikhail Popkov discovered his wife had committed adultery. Dividing women into saints and sinners, his discovery triggered a campaign of raping and then killing those he considered to be immoral. He would offer women lifts in his car and invite them for a drink. If they gave an answer of the kind 'Sorry but I must get home', they were spared, even escorted to their front doors. If they answered 'yes', this was a death sentence - an example of ‘mission killing’.
Serial killers tend to score highly on a scale of psychopathy, ticking boxes such as low empathy and glib superficial charm. Another condition that can be tapped to derive insights is anti-social personality disorder (APD). Some reports of the experiences of lust killers point to a split in individual consciousness, sometimes expressed as good versus bad personalities. There can be a sudden flip between these states. This is sometimes conceptualized as dissociation and can be revealed as ‘voices in the head’. It is distinct from psychosis and has not been successful as a plea for mitigation. Characteristics of dissociation include viewing oneself from a distance, having a poor or no memory of the killing (i.e. memory specific to the state at the time of the killing) or seeing a disliked person as the target of the attack. Some serial killers are diagnosed as psychotic.
We know a lot about Jack the Ripper’s crimes, but have no idea as to who he was. His crimes had a sexual character, and his dislike of women could be because he caught venereal disease from one. He targeted, amongst other regions, the women’s sex organs. We don’t know the identity of the Zodiac Killer, who targeted courting couples. It is likely that he felt envy towards them. Although Albert DeSalvo was widely believed to be the ‘Boston Strangler’, not everyone is in agreement about this and he was not found guilty of these crimes. However, his toxic upbringing and his characteristics of offending fit the pattern of other known serial killers. He showed evidence of dissociation. DNA evidence points to his involvement in at least one of the murders. A perspective of motivation might cast some light on these cases.
Drugs and addiction are relevant to the present study: (1) by analogy with drug-taking, the term ‘addiction’ can be applied to serial killing even where drugs are not involved and (2) drugs play an important role in the lives of some serial lust killers. The discussion first turns to two killers where the term ‘addiction’ has been applied but where it appears that drugs were not used. It then looks at two examples of drug-associated killing. Serial lust killer Michael Ross described feeling assailed by intrusive thoughts urging the rape and murder of women. He published an account of his experience in an academic journal concerned with addiction. Joel Rifkin was adopted and seriously bullied by his peers. He described his sexual behaviour as addictive and gave evidence of ambivalence in his killings. Anthony Sowell appears to have been influenced in his sexual addiction by extensive use of crack cocaine.
This chapter integrates different parts of the book. A general model of motivation involves dopamine underlying the 'wanting' part and opioids the 'liking' part. Humans (and other mammals) appear to strive to maintain their mood within a tolerable zone, if necessary, through addictive activities. A widely observed feature amongst sexual serial killers is an early history of abuse, bullying and taunting. Many killers have failed to develop any bonding with an adult caregiver. High levels of stress are evident throughout their lives. Stressors that seem to carry particular weight are those of humiliation in social interaction, where revenge might seem appropriate. Chronic stressors repeated over years can be distinguished from the acute stressors that often immediately precede a killing. Many heterosexual killers disapproved of what they perceived to be immorality of an important female, such as a mother or wife. Sibling rivalry and excessive drug/alcohol intake characterize some of those described here.
Sex-linked killing is based upon a combination of factors. Michael Apter uses the English killer Neville Heath to emphasize one of these: the irresistible lure of excitement. It is unclear what factors in life led Heath down this pathological route. A bomber pilot in World War II, Heath was reckless and disorganized, exemplifying not just sensation seeking but also sexual sadism. It would appear that Heath’s level of brain arousal had a tendency to be well below the optimal level for comfort. Therefore, he engaged in a range of daredevil reckless activities in an attempt to elevate arousal. Tall, charming and handsome, Heath exemplifies where sexual desire can combine with a desire to elevate arousal. Despite admitting that the evidence suggested his guilt, Heath reported having no memory of the killings, pointing to the possibility of dissociation. Heath was judged as sane and fit to plead and was executed.
A desire for belonging is a fundamental feature of humans. Securing and maintaining a bond is rewarding, whereas abandonment, jilting and loneliness trigger strongly aversive feelings. The chapter’s emphasis is upon belonging, and the theoretical basis of understanding Jeffrey Dahmer and Dennis Nilsen is different from those in the preceding chapters. They seem to be motivated by a combination of sexual desire and an abnormally powerful desire to avoid rejection and loneliness. This led them in a perverse direction whereby the need might even be met by a zombie partner. This raises the question of whether finding early on a conventional secure and compliant attachment could have prevented their killings. There is little or no evidence to suggest that they enjoyed killing or held sadistic desires. Dahmer suffered from neglect. Nilsen seemed to imprint upon the image of his dead grandfather.
Studies investigating the structure of the amygdala in relation to dissociation in psychiatric disorders are limited and have reported normal or preserved, increased or decreased global volumes. Thus, a more detailed investigation of the amygdala is warranted. Amygdala global and subregional volumes were compared between individuals with dissociative identity disorder (DID: n = 32) and healthy controls (n = 42). Analyses of covariance did not show volumetric differences between the DID and control groups. Although several unknowns make it challenging to interpret our findings, we propose that the finding of normal amygdala volume is a genuine finding because other studies using this data-set have presented robust morphological aberrations in relation to the diagnosis of DID.
Experiences of felt presence (FP) are well documented in neurology, neuropsychology and bereavement research, but systematic research in relation to psychopathology is limited. FP is a feature of sensorimotor disruption in psychosis, hypnagogic experiences, solo pursuits and spiritual encounters, but research comparing these phenomena remains rare. A comparative approach to the phenomenology of FP has the potential to identify shared and unique processes underlying the experience across these contexts, with implications for clinical understanding and intervention.
We present a mixed-methods analysis from three online surveys comparing FP across three diverse contexts: a population sample which included people with experience of psychosis and voice-hearing (study 1, N = 75), people with spiritual and spiritualist beliefs (study 2, N = 47) and practitioners of endurance/solo pursuits (study 3, N = 84). Participants were asked to provide descriptions of their FP experiences and completed questionnaires on FP frequency, hallucinatory experiences, dissociation, paranoia, social inner speech and sleep. Data and code for the study are available via OSF.
Hierarchical linear regression analysis indicated that FP frequency was predicted by a general tendency to experience hallucinations in all three studies, although paranoia and gender (female > male) were also significant predictors in sample 1. Qualitative analysis highlighted shared and diverging phenomenology of FP experiences across the three studies, including a role for immersive states in FP.
These data combine to provide the first picture of the potential shared mechanisms underlying different accounts of FP, supporting a unitary model of the experience.
This chapter focuses on the chaconne and demonstrates how existing approaches to pitch in Adès’s employment of the form in Arcadiana, Concerto conciso and the Violin Concerto are enriched through an appreciation of his handling of rhythm and texture to generate larger-scale musical and dramatic structures. In the three instrumental movements examined in this chapter the pitch structure of Adès’s chaconnes undergo the usual kinds of changes expected of this variation form. Attending to only the pitch organisation does not provide a complete picture of the complexities of an Adèsian chaconne. For Adès, the repetition of the chaconne cycle provides an opportunity to superimpose independent layers of rhythmic patterns that heighten and enrich the pitch and harmonic musical transformations. The temporal implications of Adès’s chaconnes provide new insights into the processes that structure his form on the larger scale.