Abnormal Psychology

Dissociative and Somatoform Disorders 349

media, the therapist, and general social expectations (Lilienfeld et al., 1999)? Propo-

nents of the sociocognitive model recognize that childhood trauma can—at least in

some cases—indirectly be associated with DID: it is possible that childhood trauma

can lead people to become more suggestible or more able to fantasize, which can

magnify the effects on their behavior of social interactions with a therapist (Lilienfeld

et al., 1999). In other words, dissociation and DID symptoms may be indirect results

of childhood trauma rather than direct posttraumatic results.

Proponents of the sociocognitive model point out that cultural influences,

such as the airing of the movie Sybil, may have led therapists to ask leading ques-

tions regarding DID—and may have led highly suggestible patients to follow these

leads unconsciously; such infl uences would account for the great variability in the

number of cases over time. Proponents of the posttraumatic model counter that

the increased prevalence of DID after 1976 simply refl ects improved procedures for

assessment and diagnosis. In support of their position, they point to the results of a

study that is consistent with their model and contradicts the sociocognitive model:

Women who reported having recovered memories (i.e., knowledge of prior events

about which they previously had no memory) of childhood sexual abuse were less

suggestible than women in a control group, not more suggestible, as would be pre-

dicted by the sociocognitive model (Leavitt, 1997). However, this study’s support

for the posttraumatic model isn’t as strong as it might seem at fi rst blush. Partici-

pants in the study were not DID patients, and so there may be some important dif-

ference between those who recover memories of childhood abuse and don’t develop

DID versus those who do go on to develop DID.

In sum, we do know that severe trauma can lead to dissociative disorders and

can have other adverse effects (Putnam, 1989; Putnam et al., 1995). However, we

do not know whether all of those who are diagnosed with DID have actually expe-

rienced traumatic events, nor even how severe an event must be in order to be con-

sidered “traumatic.” Similarly, experiencing a traumatic event does not specifi cally

cause DID (Kihlstrom, 2005); some people respond by developing depression or

an anxiety disorder. Further, as noted in Chapter 7, many people who experience a

traumatic event do not develop any psychological disorder.

Treating Substance Use Disorders

In general, dissociative disorders improve spontaneously, without treatment. This

is especially true of dissociative amnesia and dissociative fugue. However, clini-

cians who encounter people with these disorders have used some of the treatments

discussed below. Because dissociative disorders are so rare, few systematic studies

of treatments have been conducted—and none have attempted to determine which

treatments are most effective for a particular dissociative disorder. Thus, we con-

sider treatments for dissociative disorders in general.

Targeting Neurological Factors: Medication

In general, medication is not used to treat the symptoms of dissociative disorders

because research suggests that it is not helpful for dissociative symptoms (Sierra

et al., 2003; Simeon, Stein, & Hollander, 1998). However, people with DID may

receive medication for a comorbid disorders or for anxiety or mood symptoms that

arise in response to the dissociative symptoms.

Targeting Psychological and Social Factors:

Coping and Integration

Treatments that target the psychological factors underlying dissociative disorders

focus on three elements: (1) reinterpreting the symptoms so that they don’t create

stress or lead the patient to avoid certain situations; (2) learning additional coping

strategies to manage stress (Hunter et al., 2005); and (3) for DID patients, address-

ing the presence of alters and dissociated aspects of their memories or identities. The

fi rst two foci are similar to those for treating PTSD (Kluft, 1999; see Chapter 7).

Simply being sensitive to context or responding

differently when in different emotional states

does not mean that you have alters. For example,

one study found that people who are bilingual

responded differently to a personality test, de-

pending on which language was used for the test

(Ramírez-Esparza et al., 2006). Can you think of

reasons for this result that do not involve alters?

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