An invaluable sourcebook on the complex relationship between psychosis, trauma, and dissociation, thoroughly revised and updated This revised and updated second edition of Psychosis, Trauma and Dissociation offers an important resource that takes a wide-ranging and in-depth look at the multifaceted relationship between trauma, dissociation and psychosis. The editors – leaders in their field – have drawn together more than fifty noted experts from around the world, to canvas the relevant literature from historical, conceptual, empirical and clinical perspectives. The result documents the impressive gains made over the past ten years in understanding multiple aspects of the interface between trauma, dissociation and psychosis. The historical/conceptual section clarifies the meaning of the terms dissociation, trauma and psychosis, proposes dissociation as central to the historical concepts of schizophrenia and borderline personality disorder, and considers unique development perspectives on delusions and the onset of schizophrenia. The empirical section of the text compares and contrasts psychotic and dissociative disorders from a wide range of perspectives, including phenomenology, childhood trauma, and memory and cognitive disturbances, whilst the clinical section focuses on the assessment, differential diagnosis and treatment of these disorders, along with proposals for new and novel hybrid disorders. This important resource: • Offers extensive updated coverage of the field, from all relevant perspectives • Brings together in one text contributions from scholars and clinicians working in diverse geographical and theoretical areas • Helps define and bring cohesion to this new and important field • Features nine new chapters on: conceptions of trauma, dissociation and psychosis, PTSD with psychotic features, delusions and memory, trauma treatment of psychotic symptoms, and differences between the diagnostic groups on hypnotizability, memory disturbances, brain imaging, auditory verbal hallucinations and psychological testing Written for clinicians, researchers and academics in the areas of trauma, child abuse, dissociation and psychosis, but relevant for psychiatrists, psychologists and psychotherapists working in any area, the revised second edition of Psychosis, Trauma and Dissociation makes an invaluable contribution to this important evolving field.

In the 100 years since Eugen Bleuler unveiled his concept of schizophrenia, which had dissociation at its core, the essential connection between traumatic life events, dissociative processes and psychotic symptoms has been lost. Psychosis, Trauma and Dissociation is the first book to attempt to reforge this connection, by presenting challenging new findings linking these now disparate fields, and by comprehensively surveying, from a wide range of perspectives, the complex relationship between dissociation and psychosis. A cutting-edge sourcebook, Psychosis, Trauma and Dissociation brings together highly-respected professionals working in the psychosis field with renowned clinicians and researchers from the fields of traumatic stress, dissociation and the dissociative disorders, and will be of interest to those working with or studying psychotic or dissociative disorders, as well as trauma-related conditions such as borderline personality disorder or complex post-traumatic stress disorder. It makes an invaluable contribution to the burgeoning literature on severe mental disorders and serious life events. The book has three sections: Connecting trauma and dissociation to psychosis - an exploration of the links between trauma, dissociation and psychosis from a wide range of historical and theoretical perspectives. Comparing psychotic and dissociative disorders - a presentation of empirical and clinical perspectives on similarities and differences between the two sets of disorders. Assessing and treating hybrid and boundary conditions - consideration of existing and novel diagnostic categories, such as borderline personality disorder and dissociative psychosis, that blend or border dissociative and psychotic disorders, along with treatment perspectives emphasising humanistic and existential concerns.

Background: High levels of dissociation have been found in recent studies involving psychiatric inpatients. Proponents of the 'dissociative psychoses' have found that trauma-focused intervention strategies can improve outcomes of patients with major mental illness. Despite this, levels of dissociation have not been measured in forensic inpatients in Scotland. This study investigates levels of dissociative symptoms (DES-II) within a sample of male patients in secure forensic psychiatry settings in Scotland. It explores levels of psychosis (PANSS) and self-reported childhood trauma (CTQ), current PTSD symptoms (IES-R), levels of depression (BDI-II) and broad attachment style (RQ). Four groups were arbitrarily defined based on presence or absence of psychosis and childhood trauma. It was hypothesised that levels of dissociation would be predicted by presence of childhood trauma. Methods: A quantitative cross-sectional design was used in which 56 mentally disordered offenders were interviewed across three different secure hospitals in Scotland: The State Hospital - a maximum security psychiatric hospital, and two medium secure facilities. Attempts are made to clarify the relationship of dissociation with different types of childhood trauma and psychosis symptom clusters. By splitting the data into groups the study seeks to discern whether the groups differ significantly on dissociation scores in relation to the childhood experiences they reported and presence of psychosis they are experiencing. Results: Childhood traumatic experiences were frequent where median CTQ total score = 47.0 (IQR: 42-70.5). Physical neglect was reported by 58.9% of the sample closely followed by emotional neglect (55.4%). 46.4% of the sample reported physical abuse of significant levels, 44.6% reported being emotionally abused and almost a third reported being sexually abused (28.6%). DES-II (dissociation) scores were significantly associated with delusions and hallucinatory behaviour from PANSS. Emotional abuse and sexual abuse were significantly associated with dissociation scores. Mann Whitney tests revealed that dissociation was significantly higher in the groups which reported childhood trauma. Kruskal-Wallis results indicated no significant differences between groups within the data and dissociation scores. Conclusion: Patients with clinically significant levels of dissociative symptoms were identified. This indicates that dissociation is a key characteristic, warranting further consideration in this sample. Levels and severity of reported childhood trauma were higher than expected. The findings add weight and support to the importance of dissociation and trauma in formulations of male, mentally disordered offenders. Clinical implications of these findings are considered and further directions are discussed.

An international look at the similarities and differences of long-lasting trauma Trauma and Dissociation in a Cross-Cultural Perspective examines the psychological, sociological, political, economic, and cultural aspects of trauma and its consequences on people around the world. Dispelling the myth that trauma-related dissociative disorders are a North American phenomenon, this unique book travels through more than a dozen countries to analyze the effects of long-lasting traumatization-both natural and man-made-on adults and children. Working from theoretical and clinical perspectives, the field’s leading experts address trauma in situations that range from the psychological effects of “the Troubles” in Northern Ireland to the emergence of “Hikikomori,” the phenomenon of social withdrawal in Japanese youth. Reactions to trauma can be both unique according to a person’s culture and similar to the experiences of others around the world. Dissociation, intense grief, anger, and survivor’s guilt are common responses as people split off mentally, physically, and emotionally from the source of the trauma, whether it’s an act of nature (tsunami, earthquake, flood, etc.) or the trauma created by violence, physical, sexual, and emotional abuse, assault, confinement, kidnapping, and war. Trauma and Dissociation in a Cross-Cultural Perspective examines the efforts of clinicians and researchers in Europe, Asia, the Middle East, South America, Australia, and New Zealand to develop sociopsychological methods of providing counseling to people who are suffering physically, emotionally and spiritually, training for professionals counted on to dispense that counseling, and economic and political solutions that might help to limit the devastating effects of natural disasters. Trauma and Dissociation in a Cross-Cultural Perspective examines: the tensions between the National Health Service and the private sector in the United Kingdom how the Mandarin version of the Dissociative Experiences Scale (DES) is used in China Djinnai, a culture-bound syndrome and possession trance disorder found in Iran how colonialism has transmitted trauma to the Maori people of New Zealand transgenerational trauma in Turkey religious rituals and spirit possession in the Philippines “memory wars” in Israel traumatic syndromes among the French differences in dissociative experiences among Chinese and Japanese youth childhood trauma in Argentina and much more Trauma and Dissociation in a Cross-Cultural Perspective is an enlightening professional resource for anyone working in psychology, sociology, psychiatry, and psychotherapy.

An exploration of the newfound connections between mental illness and trauma For decades, the idea that serious mental illnesses (SMIs) are almost exclusively biologically-based and must be treated pharmacologically has been commonplace in psychology literature. As a result, many mental health professionals have stopped listening to their clients, categorizing their symptoms as manifestations of neurologically-based disturbed thinking. Trauma and Serious Mental Illness is the groundbreaking series of works that challenge this standard view and provides a comprehensive introduction to the emerging perspective of SMIs as trauma-based. This unique collection illustrates how different psychotherapy approaches can lead to reduced symptomatology, decreased psychological distress, and improved functioning in individuals living with SMIs. Each extensively-referenced chapter in Trauma and Serious Mental Illness offers mental health workers a forward-looking theoretical inquiry, empirical study, or critical treatise providing compelling counter evidence to challenge the widespread belief that SMIs are not reactions to the extreme and extremely disturbing circumstances embodied by psychological trauma. In addition to the etiological application, this revealing text proposes ways to incorporate this cutting-edge approach toward treatment options as well. Contributors to Trauma and Serious Mental Illness suggest that: childhood trauma is related to psychotic disorders dissociation can be confounded with psychotic symptoms auditory hallucinations can be diagnostic of dissociation rather than psychosis psychosis is related to the quality of family of origin environment and to age of onset of childhood abuse bipolar and trauma-related disorders sometimes overlap individuals with SMIs suffer related trauma even in treatment facilities and much more! Trauma and Serious Mental Illness is an eye-opening resource for mental health professionals, psychologists, counselors, psychiatrists, social workers, trauma workers, and educators and students in these disciplines.

The relatively frequent occurrence of rapid onset and very brief, but often florid, psychotic states, with periodic recurrence, alongside relatively low rates of PTSD and chronic psychosis, were unexpected findings from the 2004 East Timor Mental Health Study, conducted in the context of the country’s recently won independence and in the wake of the atrocities endured in the protracted fight for sovereignty. Further unanticipated was the frequent association of recurrence with the time of the new moon (fulan lotuk) and other times or places of sacred (lulik) or associated cultural significance. The perceived violation of culturally sacrosanct lulik obligations often also appeared to foreshadow the initial onset of such patterns of distress. Significant episodes of trauma and loss appeared a hidden feature of affected individuals histories, which we argue have become symbolically entwined with local cultural understandings of ritual obligation, sacredness, and taboo. This volume develops a dynamic but contextualized multi-level formulation of psychosis and psychotic-symptoms, able to incorporate a range of factors from the biological, through the sociocultural, to the political. The work is truly interdisciplinary drawing on both the quantitative and qualitative findings of our own study but further supported through local ethnography and broader anthropological enquiry into the outcomes of psychosis in non-Western settings; psychoanalysis and psychoanalytic anthropology; evidence and theory exploring links between trauma, dissociation and psychosis; and novel culturally-adaptable psychosocial focused interventions for psychosis. We situate both evidence and theorising in wider epistemological and political context, including in relation to the movement for Global Mental Health. Culturally patterned presentations of brief remitting-relapsing psychosis are ultimately conceived as the trade-off between competing fragmentary and synthetic forces: the former in part secondary to the lasting and deleterious effects of overwhelming loss, trauma and adversity; the latter emboldened by cultural meaning and social response in the context of broad ecological pressures demanding survival and resilience.

There is abundant evidence showing a strong association between trauma exposure, psychotic symptoms, and posttraumatic stress disorder (PTSD). Early trauma exposure contributes to the formation of psychotic symptoms and the development of psychotic disorders or severe mental illnesses such as schizophrenia, bipolar disorder, and treatment-refractory major depression. Furthermore, among persons with psychotic disorders, multiple traumatization over the lifetime is common, due to factors such as social stigma, the criminalization of severe mental illness, and increased vulnerability to interpersonal victimization. In addition to these factors is the traumatic nature of experiencing psychotic symptoms and coercive treatments such as involuntary hospitalization and being placed in seclusion or restraints. Not surprisingly, these high rates of trauma lead to high rates of PTSD in people with psychotic disorders, which are associated with more severe symptoms, worse functioning, and greater use of acute care services. In addition to the impact of trauma on the development of psychotic disorders and comorbid PTSD, traumatic experiences such as childhood sexual and physical abuse can shape the nature of prominent psychotic symptoms such as the content of auditory hallucinations and delusional beliefs. Additionally, traumatic experiences have been implicated in the role of ‘stress responsivity’ and increased risk for transition to psychosis in those identified as being at clinical high risk of developing psychosis. Finally, although the diagnostic criteria for PTSD primarily emphasize the effects of trauma on anxiety, avoidance, physiological over-arousal, and negative thoughts, it is well established that PTSD is frequently accompanied by psychotic symptoms such as hallucinations and delusions that cannot be attributed to another DSM-V Axis I disorder such as psychotic depression or schizophrenia. Understanding the contribution of traumatic experiences to the etiology of psychosis and other symptoms can inform the provision of cognitive behavioral therapy for psychosis, including the development of a shared formulation of the events leading up to the onset of the disorder, as well as other trauma-informed treatments that address distressing and disabling symptoms associated with trauma and psychosis. Until recently the trauma treatment needs of this population have been neglected, despite the high rates of trauma and PTSD in persons with psychotic disorders, and in spite of substantial gains made in the treatment of PTSD in the general population. Fortunately, progress in recent years has provided encouraging evidence that PTSD can be effectively treated in people with psychotic disorders using interventions adapted from PTSD treatments developed for the general population. In contrast to clinician fears about the untoward effects of trauma-focused treatments on persons with a psychotic disorder, research indicates that post-traumatic disorders can be safely treated, and that participants frequently experience symptom relief and improved functioning. There is a need to develop a better understanding of the interface between trauma, psychosis, and post-traumatic disorder. This Frontiers Research Topic is devoted to research addressing this interface.

Presentation of a major new diagnostic interview to assess chronic trauma-related disorders, in particular dissociative disorders. Written by a world-leading specialist in trauma-related dissociation, this book comprehensively describes the diagnosis of trauma-related disorders, taking up the many dilemmas around criteria in DSM-5 and ICD-11, symptom recognition, the role of traumatic experiences and of self-report questionnaires, as well as other topics. The book elaborates on the assessment of these disorders, using the diagnostic instrument Trauma and Dissociative Symptoms Interview (TADS-I), developed by the author over decades of work in the field. Several thematic chapters discuss key differential diagnostic considerations and illustrate them with case reports. Also discussed are the occurrence of false-negative and false-positive diagnoses of trauma-related dissociative disorders, the assessment of traumatic experiences, and the development of a treatment plan. This book is essential reading for clinicians who diagnose dissociative disorders (or want to learn), and useful for those who want to assist in better recognizing clients with dissociative symptoms and refer them for specialized testing. The complete TADS-I is included as an appendix.

Attachment: New Directions in Psychotherapy and Relational Psychoanalysis is a leading-edge journal for clinicians working relationally with their clients. It is a professional journal, featuring cultural articles, politics, reviews and poetry relevant to attachment and relational issues; an inclusive journal welcoming contributions from clinicians of all orientations seeking to make a contribution to attachment approaches to clinical work; an international journal open to ideas and practices from all countries and cultures; and a cutting-edge journal with up-to-date briefings on latest developments in neuroscience relevant to psychotherapy and counselling. Articles - Daughter, My Generation is Squandering Your Birthright by George Monbiot - Fifty Years Ago: John Bowlby Recommends the Use of a Single Case Study to Understand a Child’s Detached Relationships by Juliet Hopkins - On the Relation Between Trauma, Dissociation, Psychotic Symptoms, and Schizophrenia by Andrew Moskowitz - Working With Dissociation by Philippa Perry - On Borrowed Time by Rachael Gasson - Attachment, Trauma, and Organisations by Mark Linington

This volume presents a comprehensive overview of childhood trauma, considering the psychopathological definition and its neurobiological implications as well as its impact on different psychiatric disorders. The focus on childhood trauma rather than that occurring in adulthood is important due to its general “neuro-psyco-socio” and its specific biological implications, since trauma during childhood impacts directly on neurodevelopment. It has been suggested that early life stress increases vulnerability to psychiatric disorders; however, the exact mechanisms of this association are not yet completely understood. Although childhood trauma could be considered too unspecific to be an important risk factor for individual psychiatric disorders since it seems to occur across the board, it impacts differently on different psychiatric disorders, and it can modulate their clinical expression. Therefore, the assessment of early trauma needs to be included in the clinical evaluation of patients with psychiatric disorders. The volume will be an invaluable tool for psychiatrists, helping them to select suitable pharmacological, psychotherapeutic and rehabilitative treatments.