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Am Fam Physician. 1999;60(3):972

Dissociative symptoms are disruptions in usually integrated functions of consciousness such as memory, identity and perception of the environment. Whether dissociation is primarily a response to overwhelming experiences, especially in childhood, is a subject of debate. Research examining the relationship between childhood trauma and adult dissociation has focused primarily on sexual and physical abuse. Little is known about the effect of co-existing distressing circumstances such as parental loss, witnessing interparental violence and chronic neglect. Draijer and Langeland examined the level of dissociation in relation to childhood events to evaluate the effect of multiple victimization and dissociative response.

A total of 160 psychiatric inpatients consecutively admitted to a general psychiatric hospital were given the Dissociative Experiences Scale and the Structured Trauma Interview. The Dissociative Experiences Scale is the most widely used screening instrument for dissociative symptoms in clinical samples. The Structured Trauma Interview evaluates childhood experiences that have proved to be risk factors for adult psychopathology, as well as the effect of adult sexual and physical abuse.

Results demonstrated that childhood experiences were interrelated. Early separation from a parent was related to sexual and physical abuse and to witnessing interparental violence; sexual and physical abuse were related; and physical abuse was related to witnessing interparental violence, but sexual abuse was not. Mothers were reported to have dysfunctional behaviors more often than fathers. The severity of the maternal dysfunction was related to early separation, witnessing violence and sexual abuse.

The severity of each patient's dissociative symptoms was significantly related to reported physical and sexual abuse but not to early separation. The highest dissociative scores occurred in patients who were sexually abused by family members and non-family members and those who suffered a combination of sexual and physical abuse. Patients who reported having mothers who drank heavily experienced the most significant dissociative symptoms.

Childhood stressors in the form of severe physical or sexual abuse or repetitive sexual trauma caused the most severe dissociative symptoms. Multiple victimization, particularly occurring within the context of intimate relationships, appeared to reinforce the dissociative response. Witnessing violence and early separation from a parent did not significantly contribute to adult dissociative symptoms. The authors note that secrecy and denial are strongly associated with childhood physical and sexual abuse. The significance of maternal dysfunction in cases of adult dissociation refutes the theoretic assumption of a single trauma-related etiology of dissociation.

The authors conclude that their findings support the clinical observation that patterns of insecure/disorganized attachment are related to increased levels of dissociation as adults. Perceived dysfunction or unavailability of the mother seems to be important and indicates the importance of early positive attachments between parent and child. These findings emphasize the importance of the establishment of trust by physicians who may be caring for patients who have experienced childhood abuse.

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