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.Sixty-eightpercent reported incest.Ross et al.(1990) found that, of 97 cases, 95% reportedphysical or sexual abuse.Unfortunately, the abuse seems often as bizarre and sadisticas what Sybil suffered.Some children were buried alive.Some were tortured withmatches, steam irons, razor blades, or glass.Investigators have corroborated theexistence of at least some early sexual abuse in 12 patients with DID, whosebackgrounds were extensively investigated by examining early records, interviewingrelatives and acquaintances, and so on (Lewis, Yeager, Swica, Pincus, & Lewis,Durand 5-741997), although Kluft (1996, 1999) notes that some reports by patients are not true buthave been confabulated (made up).Not all the trauma is caused by abuse.Putnam (1992) describes a young girl in awar zone who saw both her parents blown to bits in a minefield.In a heart-wrenchingresponse, she tried to piece the bodies back together, bit by bit.Such observations have led to wide-ranging agreement that DID is rooted in anatural tendency to escape or  dissociate from the unremitting negative affectassociated with severe abuse (Kluft, 1984, 1991).A lack of social support during orafter the abuse also seems implicated.A study of 428 adolescent twins demonstratedthat a surprisingly high 33% to 50% of the variance in dissociative experience couldbe attributed to a chaotic, nonsupportive family environment.The remainder of thevariance was associated with individual experience and personality factors (Waller &Ross, 1997).The behavior and emotions that make up disorders seem related to otherwisenormal tendencies present in all of us to some extent.It is common for otherwisenormal individuals to escape in some way from emotional or physical pain (Butler,Duran, Jasiukaitis, Koopman, & Spiegel, 1996; Spiegel & Cardeña, 1991).Noyes andKletti (1977) surveyed more than 100 survivors of various life-threatening situationsand found that most had experienced some type of dissociation, such as feelings ofunreality, a blunting of emotional and physical pain, and even separation from theirbodies.Dissociative amnesia and fugue states are clearly reactions to severe lifestress.But the life stress or trauma is in the present rather than in the past, as in thecase of the overwrought mother who suffered from dissociative amnesia.Manypatients are escaping legal difficulties or severe stress at home or on the job (Sackeim& Devanand, 1991).But sophisticated statistical analyses indicate that  normalDurand 5-75dissociative reactions differ substantially from the pathological experiences we vedescribed (Waller, Putnam, & Carlson, 1996; Waller & Ross, 1997) and that at leastsome people do not develop severe pathological dissociative experiences no matterhow extreme the stress.These findings are consistent with our diathesis stress modelin that only with the appropriate vulnerabilities (the diathesis) will a person react tostress with pathological dissociation.You may have noticed that DID seems similar in its etiology to posttraumaticstress disorder (PTSD).Both conditions feature strong emotional reactions toexperiencing a severe trauma (Butler et al., 1996).But remember that not everyonegoes on to experience PTSD after severe trauma.Only people who are biologicallyand psychologically vulnerable to anxiety are at risk for developing PTSD in responseto moderate levels of trauma.There is a growing body of opinion that DID is an extreme subtype of PTSD, witha much greater emphasis on the process of dissociation than on symptoms of anxiety,although both are present in each disorder (Butler et al., 1996).Some evidence alsoshows that the  developmental window of vulnerability to the abuse that leads toDID closes around 9 years of age (Putnam, 1997).After that, DID is unlikely todevelop, although severe PTSD might.If true, this is a particularly good example ofthe role of development in the etiology of psychopathology.We also must remember that we know relatively little about DID.Our conclusionsare based on retrospective case studies or correlations rather than on the prospectiveexamination of people who may have undergone the severe trauma that seems to leadto DID (Kihlstrom, Glisky, & Anguilo, 1994).Therefore, it is hard to say whatpsychological or biological factors might contribute, but there are hints concerningindividual differences that might play a role.Durand 5-76Suggestibility Suggestibility is a personality trait distributed normally across thepopulation, much like weight and height.Some people are much more suggestiblethan others, some are relatively immune to suggestibility, and the majority fall in themidrange.Did you ever have an imaginary childhood playmate? Many people did, and it isone sign of the ability to lead a rich fantasy life, which can be helpful and adaptive.But it also seems to correlate with being suggestible or easily hypnotized (somepeople equate the terms suggestibility and hypnotizability).A hypnotic trance is alsosimilar to dissociation (Bliss, 1986; Butler et al., 1996; Carlson & Putnam, 1989).People in a trance tend to be focused on one aspect of their world, and they becomevulnerable to suggestions by the hypnotist.There is also the phenomenon of self-hypnosis, in which individuals can dissociate from most of the world around them and suggest to themselves that, for example, they won t feel pain in one of their hands.According to the autohypnotic model, people who are suggestible may be able touse dissociation as a defense against extreme trauma (Putnam, 1991) [ Pobierz caÅ‚ość w formacie PDF ]