Trauma & Dissociation in the DSM5: Where Do They Fit?

Spiegel, D. (2010).  Dissociation in the DSM5.  Journal of Trauma & Dissociation, 11, 261-265.

In David Spiegel’s most recent Editorial in the Journal of Trauma & Dissociation, he discusses some of the possible changes for dissociative disorders in the upcoming DSM5.  Speigel describes the tenuous position of dissociative disorders in our current nosology and suggests that this is because

They are right at the border of could and would, losses of control over cognitive functions such as memory, identity, and consciousness, that we take pride in managing. They both result in severe mental dysfunction and yet seem transient (at least in overt presentation) and controllable. They force us to reexamine our assumptions about the solidity of identity and the consistency of our control over our minds and bodies. And, even worse, they often result from trauma, frequently severe and repeated sexual and physical abuse early in life, leading to moral judgments and concern about the accuracy of trauma reports. Thus, dissociative disorders are contentious and have been poorly integrated into our diagnostic systems. (p. 262).

The Anxiety, Obsessive–Compulsive Spectrum, Traumatic, and Dissociative Disorders Work Group is currently considering including dissociative and traumatic stress disorders along a stress and trauma spectrum.  Spiegel notes that this would represent a rather significant ideological shift away from the DSM-IV anti-theoretical stance that avoids speculation about causality.  However, trauma-related anxiety disorders have always included an implicit assumption that they are caused by the stress or trauma that incites the symptoms.

So where’s the rub?  Dissociative disorders have never required exposure to a traumatic event in order to diagnose, although most clinicians and researchers agree that dissociative disorders are most commonly a response to severe and/or chronic trauma (Putnam, 1997; Spiegel & Cardena, 1991).  Do disorders of traumatic stress (resulting directly from exposure to a traumatic event) belong on the same spectrum as dissociative disorders (often, thought not exclusively, a result of exposure to a traumatic event)?  The DSM5 taskforce is in the process of designing field trials for new diagnostic criteria, and updates can be found here.

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A New Type of PTSD?

Lanius, R.A., Vermetten, E., Loewenstein, R.J., Schmal, C., Brenner, D.J., & Spiegel, D. (2010).  A dissociative subtype of PTSD: Clinical and neurobiological evidence.  American Journal of Psychiatry, 167, 640-647.

Psychology’s daignostic nosology, the DSM-IV-TR, is currently under intense scrutiny by many professionals in the field as it is in the middle stages of revision (soon to be DSM5).  In the current edition of the DSM-IV-TR, the diagnostic criteria for PTSD require that the victim demonstrate or report 1 symptom of re-experiencing (flashbacks, nightmares, intrusive thoughts & images, etc.), 3 symptoms of avoidance, and 2 symptoms of hyper-arousal (increased startle response, sleep disturbance, etc.).  Although the largest symptom-requirement for PTSD falls under the avoidance category, symptoms of intrusive re-experiencing and physiological hyper-arousal are most commonly treated first and are often thought as the “hallmark” symptoms.

In the article cited above, Lanius and colleagues argue that the current DSM-IV-TR diagnostic criteria reflect a non-dissociative type of PTSD, or a type of PTSD in which there is an under-modulation of affect and re-experience and arousal symptoms predominate.   Continue reading

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Part I: A Guide to Juvenile Dependence Proceedings

Much of my clinical experience has been with children who are dependents of the court; in other words, children who have been removed from the home for one reason or another.  The California juvenile dependency court system can be overwhelming to caregivers caring for young relatives or first-time foster parents.  This post will outline the overall process of dependency proceedings, and is a reflection of both my experience navigating this system and published material from the Judicial Council of California.  In Part II, I will detail the kinds of information that you as a caregiver can offer the court that may be helpful.   Continue reading

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Child-Centered Play Therapy and Disruptive Behavior Disorders

Cochran, J.F., Cochran, N.H., Nordling, W.J., McAdam, A., & Miller, D.T. (2010). Two case studies of child-centered play therapy for children referred with highly disruptive behavior. The International Journal of Play Therapy, 19, 130-143.

In the most recent issue of The International Journal of Play Therapy, Cochran et al. (2010) detail the use of child-centered play therapy (CCPT) in the treatment of two 6-year-old male children referred for disruptive behavior disorders. For those unfamiliar with CCPT, it is a type of play-therapy that “emphasizes genuine, deep empathy and unconditional positive regard from therapist to child clients, child self-expression within necessary limits, and opportunities for the child to “think through” inter- and intra-personal conflicts in play and to use play to communicate to self and counselor in therapeutic sessions” (Cochran et al., p. 131; see also Axline, 1969; Guerney, 1983, 2001; Landreth, 2002; Nordling, 2009). The authors conceptualize disruptive behavior disorders as reflecting a foundational deficit in relating to others, and hence hypothesized that CCPT would be an effective form of treatment. Continue reading

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Child Sex Trafficking

Welcome to my blog! Ultimately, I hope to use this blog to summarize current research in the field of child psychology and child trauma for parents and providers. With all the new research available in these fields it can be hard to keep track of what’s most important and the bottom line. I hope to help make that easier for you.

Although I do not intend to use this blog to promote sociopolitical platforms or agendas, I will use it to alert my readers to advocacy opportunities that will help protect our children. One of those opportunities is upon us now, and I wanted to make you aware of it.

“Each year, at least 100,000 children are victimized through commercial sex and prostitution within the United States. Particularly vulnerable to sex trafficking are runaway children, an estimated 33% of them are lured into prostitution within the first 48 hours of leaving home. Unfortunately, victims of sex trafficking, including children, are commonly overlooked in most state and federal efforts to respond to the brutal crime. A mere 80 beds in shelters nationwide are available to provide the safe shelter and professional health and social services that these victims need. However, Congress is now considering legislation to provide much–needed funding to provide assistance to these victims – and your voice is needed!”

It only takes a few minutes to identify who your state senators are, and to contact them via email urging them to support S.2925. By visiting The Polaris Project you can get more information about the bill and how to help.  Please take a few moments to help protect child sex trafficking victims in the United States.

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