Dissociation, Development, and the Psychobiology of Trauma

Dissociation and dissociative disorders represent one of the most important areas in the study of human mental life. These phenomena are vitally important for psychiatry, psychology, and psychoanalysis to understand and assimilate. There are many reasons for this. Dissociative disorders are among the most common psychiatric disorders in North America and probably throughout the world (Mulhern, 1991; Ross, 1991). The development of a dissociative disorder is primarily linked to the experience of overwhelming psychological trauma. Thus, the systematic societal attempt to decrease the prevalence of avoidable traumatic experiences such as child abuse, rape, and other forms of intrafamilial violence represents the single most important area for preventive mental health in our society.

The study of the dissociative disorders is vitally important for psychoanalysis. Recent systematic studies suggest that as many as 10% of the general population suffer from a dissociative disorder and that about 1% may have multiple personality disorder (MPD) (Ross, 1991). Further, treatment-outcome data suggests that dissociative disorders, and MPD in particular, respond well to psychodynamic psychotherapy with adjunctive hypnotherapy, but are not primarily treatable by medications (Coons, 1986; Kluft, 1991b; Putnam and Loewenstein, 1993). Psychoanalytic concepts are vital to the successful treatment of MPD and related conditions (Kluft, 1989). Thus, dissociative disorders represent a major area in modern psychiatric therapeutics to which psychoanalysts can make real, tangible contributions. On the other hand, as Kluft (1992) points out: