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Goldner L, Lev-Wiesel R, Bussakorn B. "I'm in a Bloody Battle without Being Able to Stop It": The Dissociative Experiences of Child Sexual Abuse Survivors. JOURNAL OF INTERPERSONAL VIOLENCE 2023; 38:7941-7963. [PMID: 36799511 DOI: 10.1177/08862605231153865] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
Abstract
Dissociation in child sexual abuse (CSA) survivors remains under-recognized and diagnosed, partly because of the difficulties involved in identifying dissociative symptoms. Qualitative research can contribute to a better understanding of the lived experiences of dissociation. This study focused on the experiences of dissociation in the context of CSA. In all, 22 female incest survivors, all diagnosed with different dissociative disorders, provided narratives about their experiences of dissociation. The narratives were analyzed using interpretative phenomenological analysis. The narrative analysis revealed four central themes. The first theme deals with reliving the experience of the abuse. The second theme refers to the experience of disconnection from the body, the self, and the surroundings. The third theme covers the lack of coherence in the narrative, and the fourth theme describes the bridge between voluntary controlled and nonvoluntary uncontrolled use of dissociation. The data are discussed in light of several traumagenic constructs, including a lack of self-sense, being entrapped in a victim-aggressor relationship, and distorted time perception. It is suggested that the extent to which participants can control their dissociation and the coherency of their narratives reflects the severity of their dissociation. Clinicians can consider helping clients use dissociation as an adaptive defense mechanism.
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Affiliation(s)
- Limor Goldner
- Faculty of Welfare and Health Sciences, The Emili Sagol CATs Research Center, University of Haifa, Israel
| | - Rachel Lev-Wiesel
- Faculty of Welfare and Health Sciences, The Emili Sagol CATs Research Center, University of Haifa, Israel
- Tel Hai College, Upper Galilee, and the Emili Sagol CATs Research Center, University of Haifa, Israel
| | - Binson Bussakorn
- Faculty of Fine Arts, FAA-Emili Sagol Creative Arts Research and Innovation for Well-being Center, Chulalongkorn University, Bangkok, Thailand
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Lev-Wiesel R, Goldner L, Malishkevich Haas R, Hait A, Frid Gangersky N, Lahav L, Weinger S, Binson B. Adult Survivors of Child Sexual Abuse Draw and Describe Their Experiences of Dissociation. Violence Against Women 2023:10778012231155172. [PMID: 36794435 DOI: 10.1177/10778012231155172] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/17/2023]
Abstract
The paper examined how dissociation is experienced and manifested in the drawings and narratives of female survivors of childhood sexual abuse (CSA) diagnosed with dissociative identity disorder. Fifteen Israeli women filled out a self-report questionnaire consisting of demographics, traumatic events, and dissociation severity. Then, they were asked to draw a dissociation experience and provide a narrative. The results indicated that experiencing CSA was highly correlated with indicators such as the level of fragmentation, the figurative style, as well as with the narrative. Two main themes emerged: a constant movement between internal and external worlds, and distorted perceptions of time and space.
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Affiliation(s)
- Rachel Lev-Wiesel
- Social Work Department, Tel Hai College, Kiryat Shmona, Israel
- The Emili Sagol Research Center for Creative Art Therapies, University of Haifa, Haifa, Israel
| | - Limor Goldner
- The Emili Sagol Research Center for Creative Art Therapies, University of Haifa, Haifa, Israel
| | | | | | | | - Lee Lahav
- Tel Hai College, Kiryat Shmona, Israel
| | | | - Bussakorn Binson
- FAA-Emili Sagol Creative Arts Research and Innovation for Well-being Center, CU, BKK, Thailand
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Lev-Wiesel R, Ramot O, Niv H, Daniel E, Gosh Y, Dahan A, Weinger S. Physical Versus Sexual Abuse as Reflected in Adolescents' Self-Figure Drawings: A Preliminary Study. JOURNAL OF CHILD SEXUAL ABUSE 2022; 31:33-50. [PMID: 33416014 DOI: 10.1080/10538712.2020.1856993] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/25/2020] [Revised: 11/02/2020] [Accepted: 11/13/2020] [Indexed: 06/12/2023]
Abstract
Based on the lack of validated assessment tools to detect past physical or sexual abuse, the current study examines to what extent the experience of either sexual or physical abuse is reflected in self-figure drawings of adolescents at-risk. A convenience sample consists of 93 adolescents at risk between the ages of 12-17 recruited from Welfare institutes divided into three groups: Group 1 included adolescents who experienced sexual abuse, Group 2 included adolescents who experienced physical abuse but not sexual abuse, Group 3 included adolescents who experienced neither sexual abuse nor physical abuse. A self-report anonymous questionnaire that consisted of demographics, traumatic events questionnaire, and the Medical Somatic Dissociation Questionnaire (MSDQ) was administered following Ethical approval and signing of consent forms. Participants were asked to draw themselves on an A4 sheet of paper using a pencil. Five social workers who were unaware of participants' experiences assessed the drawings independently for the level of obviousness of the following indicators: face line, eyes, nose, ears, hair stand, forehead, lower body, arms, and hands. Results yielded differences in pictorial indicators (nose, hair stand, lower body) among the groups. MSDQ score was found significantly higher among sexually abused victims.
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Affiliation(s)
| | - Oren Ramot
- The Academic College of Tel-Hai, Tel Hai, Kiryat Shmona, Israel
| | - Hagar Niv
- The Academic College of Tel-Hai, Tel Hai, Kiryat Shmona, Israel
| | - Einav Daniel
- The Academic College of Tel-Hai, Tel Hai, Kiryat Shmona, Israel
| | - Yoav Gosh
- The Academic College of Tel-Hai, Tel Hai, Kiryat Shmona, Israel
| | - Amir Dahan
- The Academic College of Tel-Hai, Tel Hai, Kiryat Shmona, Israel
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Moreira ÉDS, Vale RRMD, Caixeta CC, Teixeira RAG. Automutilação em adolescentes: revisão integrativa da literatura. CIENCIA & SAUDE COLETIVA 2020; 25:3945-3954. [DOI: 10.1590/1413-812320202510.31362018] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2018] [Accepted: 01/22/2019] [Indexed: 11/22/2022] Open
Abstract
Resumo Trata-se de uma revisão integrativa da literatura acerca dos conhecimentos produzidos pela comunidade científica sobre automutilação em adolescentes no período de janeiro de 2012 a junho de 2017. A busca foi realizada nas bases de dados SCIELO e Portal CAPES, em português, inglês e espanhol com amostra final de 71 artigos. Este estudo mostrou grande número de publicações a nível internacional, com destaque para artigos epidemiológicos e fragilidade na publicação de estudos de intervenção que investiguem a eficácia de terapias e programas de prevenção.
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Moraes DX, Moreira ÉDS, Sousa JM, Vale RRMD, Pinho ES, Dias PCDS, Caixeta CC. “The pen is the blade, my skin the paper”: risk factors for self-injury in adolescents. Rev Bras Enferm 2020; 73:e20200578. [DOI: 10.1590/0034-7167-2020-0578] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2020] [Accepted: 09/13/2020] [Indexed: 11/22/2022] Open
Abstract
ABSTRACT Objective: to describe the risk factors that influence the self-injury behavior of adolescents assisted at a Psychosocial Care Center for Children and Adolescents, according to subjects’ own perceptions. Method: a descriptive, exploratory, qualitative study carried out through medical records and a focus group with 07 adolescents. The statements were submitted to thematic content analysis. Results: in the risk factors category, four subcategories emerged: Family adversity factors; Social contagion; Adverse life events; Personal characteristics. Conflicts, lack of support, drug use in the family, meeting someone who cuts themselves, social networks, religiosity, history of sexual violence and bullying were identified as risk factors that influence self-injury. Final Considerations: adolescents pointed out the need for prejudice-free dialogues in schools, in health and family devices, configuring protective factors to avoid this practice that comes from several negative events throughout life.
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Daphna-Tekoah S, Lev-Wiesel R, Israeli D, Balla U. A Novel Screening Tool for Assessing Child Abuse: The Medical Somatic Dissociation Questionnaire-MSDQ. JOURNAL OF CHILD SEXUAL ABUSE 2019; 28:526-543. [PMID: 30893027 DOI: 10.1080/10538712.2019.1581868] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/15/2018] [Revised: 11/20/2018] [Accepted: 12/19/2018] [Indexed: 06/09/2023]
Abstract
Somatic dissociation is known to be associated with childhood abuse, particularly with childhood sexual abuse (CSA). Currently, the diagnosis of CSA is hampered by the lack of a validated questionnaire. While some questionnaires are excellent research tools, there is no suitable applied measure for the assessment of distress due to CSA. The current study's objective was to validate a novel questionnaire, designated the Medical Somatic Dissociation Questionnaire-MSDQ, for evaluating somatic dissociation in the healthcare system setting. A total of 541 adults, 160 (30%) male and 381 (70%) female, of average age 35 years were recruited from the general population via the Internet. The Life Events Checklist for DSM-5 (LEC-5) was used for screening subjects for reporting a history of CSA. Our examination of the MSDQ indicated powerful internal consistency, reliability, and convergent validity of the instrument, with high correlations between the MSDQ and the SDQ-20 and also between the MSDQ and psychological symptomatology. In addition, there was known-groups validity when differences between adults who experienced CSA and those who did not were compared. Importantly, the MSDQ can be easily integrated into the evaluation process performed by medical professionals in the diagnosis of adult patients with apparently unexplained symptomatology.
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Affiliation(s)
- Shir Daphna-Tekoah
- a Kaplan Medical Center , Rehovot , Israel
- b Faculty of Social-Work , Ashkelon Academic College , Ashkelon, Israel
- c Emili Sagol Creative Arts Therapies Research Center , Mount Carmel , Haifa , Israel
| | - Rachel Lev-Wiesel
- c Emili Sagol Creative Arts Therapies Research Center , Mount Carmel , Haifa , Israel
| | - David Israeli
- a Kaplan Medical Center , Rehovot , Israel
- d Faculty of Medicine , The Hebrew University , Jerusalem, Israel
| | - Uri Balla
- a Kaplan Medical Center , Rehovot , Israel
- c Emili Sagol Creative Arts Therapies Research Center , Mount Carmel , Haifa , Israel
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Mahoney CT, Benight CC. The Temporal Relationship Between Coping Self-Efficacy and Dissociation in Undergraduate Students. J Trauma Dissociation 2019; 20:471-487. [PMID: 30924408 DOI: 10.1080/15299732.2019.1597805] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
Dissociation is a lack of information integration resulting from a process that ranges on a continuum from normative experiences (e.g., daydreaming) to a pervasive traumatic response involving alterations and/or fragmentation in mental processes such as memory, emotion, and perception. Perceived coping self-efficacy (CSE) is a cognitive appraisal ability utilized to regulate internal and external stressors that arise from traumatic events, and is crucial for effective adaptation after extreme stress or trauma. Thus, CSE may be a critical component in decreasing dissociative experiences following a traumatic event. In the present study, 136 undergraduate students (M age = 22.36 years, SD = 6.27; 81% female, 69.1% Caucasian, 77.2% attended some college) completed self-report measures of trauma, dissociation, and coping self-efficacy. All measures were completed by the same participants at two different time points (Time 1 and Time 2) two months apart; all participants reported a history of exposure to at least one Criterion A traumatic event (according to the DSM-5) at Time 1. We hypothesized that CSE for posttraumatic coping demands at Time 2 would mediate the relationship between dissociation at Time 1 and dissociation at Time 2, and subsequently found evidence of significant mediation, 95% CI [.02, .18]. These findings suggest that initial levels of persistent dissociation negatively predict CSE, which in turn directly and negatively influence persistent dissociation at a later time point. This highlights how CSE may serve as a protective factor against persistent dissociation.
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Affiliation(s)
- Colin T Mahoney
- a Department of Psychology , Idaho State University , Pocatello , ID , USA
| | - Charles C Benight
- b Department of Psychology , University of Colorado at Colorado Springs , Colorado Springs , CO , USA
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Černis E, Chan C, Cooper M. What is the relationship between dissociation and self-harming behaviour in adolescents? Clin Psychol Psychother 2019; 26:328-338. [PMID: 30690804 DOI: 10.1002/cpp.2354] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2018] [Revised: 11/29/2018] [Accepted: 12/03/2018] [Indexed: 01/13/2023]
Abstract
Deliberate self-harm in adolescents is an increasing clinical problem, but there is a limited understanding of the mechanisms causing or maintaining this behaviour. One proposed mechanism is that of dissociation. However, the role this mechanism may play is unclear: although some suggest that adolescents engage in self-harm to end the aversive experience of dissociation, others propose that self-harm is used to purposefully trigger a dissociative state to avoid emotional pain. This systematic review is the first to evaluate the available evidence regarding the relationship between dissociation and deliberate self-harm in adolescents (aged 18 or younger). Nineteen relevant studies were identified. These studies were limited by cross-sectional design and poor methods of measurement, but some important conclusions could be drawn. The majority of studies found a positive correlation between the severity of dissociation and the severity and frequency of deliberate self-harm in adolescents, and a small number of results suggest that dissociation mediates the relationship between childhood trauma and adolescent self-harm.
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Affiliation(s)
- Emma Černis
- Oxford Institute of Clinical Psychology Training, The Isis Education Centre, Oxford, UK
| | - Carmen Chan
- Horizon, Oxford Health NHS Foundation Trust, Witney, UK
| | - Myra Cooper
- Oxford Institute of Clinical Psychology Training, The Isis Education Centre, Oxford, UK
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Ram-Vlasov N, Goldner L, Lev-Wiesel R. Preliminary validation of the peri-traumatic dissociation trauma drawing assessment (PDTDA): The case of military trauma. ARTS IN PSYCHOTHERAPY 2019. [DOI: 10.1016/j.aip.2018.11.002] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Lev-Wiesel R, Bechor Y, Daphna-Tekoah S, Hadanny A, Efrati S. Brain and Mind Integration: Childhood Sexual Abuse Survivors Experiencing Hyperbaric Oxygen Treatment and Psychotherapy Concurrently. Front Psychol 2018; 9:2535. [PMID: 30618956 PMCID: PMC6302126 DOI: 10.3389/fpsyg.2018.02535] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2018] [Accepted: 11/27/2018] [Indexed: 11/25/2022] Open
Abstract
Due to evidence that traumatic experience impacts the brain, the body (concerning sensory sensitivity), and the mind, a recent study that attempted to answer the question of whether the effects of CSA can be reversed by using a multidisciplinary approach consisting of dual treatments: hyperbaric & psychotherapy, was conducted. Its results showed that in addition to improvement of brain functionality, symptoms of distress were significantly reduced. The current paper aims to present the process as experienced by the 40 female childhood sexual abuse survivor participants. Data included participants' daily journals and drawings, and participants' summaries presented verbally and written, 6-months after the study ended. A phenomenological analysis was used. Results showed three phases, the initial phase-remembering the trauma from both physical and cognitive aspects, the second phase-physiological relaxation as well as positive memories emerge; and, the third phase-bouncing back to life. The results are discussed in light of the study theoretical model and Lev-Wiesel (2015) childhood sexual abuse conceptualization.
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Affiliation(s)
- Rachel Lev-Wiesel
- The School of Creative Arts Therapies, University of Haifa, Haifa, Israel
- Emili Sagol Creative Arts Therapies Research Center, Mount Carmel, Haifa, Israel
| | - Yair Bechor
- The Sagol Center for Hyperbaric Medicine and Research, Assaf Harofeh Medical Center, Ramla, Israel
| | - Shir Daphna-Tekoah
- Emili Sagol Creative Arts Therapies Research Center, Mount Carmel, Haifa, Israel
| | - Amir Hadanny
- The Sagol Center for Hyperbaric Medicine and Research, Assaf Harofeh Medical Center, Ramla, Israel
| | - Shai Efrati
- The Sagol Center for Hyperbaric Medicine and Research, Assaf Harofeh Medical Center, Ramla, Israel
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Efrati S, Hadanny A, Daphna-Tekoah S, Bechor Y, Tiberg K, Pik N, Suzin G, Lev-Wiesel R. Recovery of Repressed Memories in Fibromyalgia Patients Treated With Hyperbaric Oxygen - Case Series Presentation and Suggested Bio-Psycho-Social Mechanism. Front Psychol 2018; 9:848. [PMID: 29896150 PMCID: PMC5987035 DOI: 10.3389/fpsyg.2018.00848] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2017] [Accepted: 05/11/2018] [Indexed: 12/15/2022] Open
Abstract
Fibromyalgia Syndrome (FMS) is a condition considered to represent a prototype of central sensitization syndrome, characterized by chronic widespread pain and along with symptoms of fatigue, non-restorative sleep and cognitive difficulties. FMS can be induced by trauma, infection or emotional stress with cumulative evidence that dissociation is relatively frequent in FMS patients. Two randomized controlled trials have shown that hyperbaric oxygen therapy (HBOT) can induce neuroplasticity and be effective in patients suffering from FMS. In this paper we present, for the first time, case series of female fibromyalgia patients who, in the course of HBOT, suddenly recalled repressed traumatic memories of childhood sexual abuse (CSA). The surfacing of the repressed (dissociative) memories decades after the sexual abuse events was sudden and utterly surprising. No psychological intervention was involved. As the memories surfaced, the physical pain related to FMS subsided. In one patient who had brain single photon emission CT (SPECT) before and after HBOT, the prefrontal cortex appeared suppressed before and reactivated after. The 3 cases reported in this article are representative of a total of nine fibromyalgia patients who experienced a retrieval of repressed memory during HBOT. These cases provide insights on dissociative amnesia and suggested mechanism hypothesis that is further discussed in the article. Obviously, prospective studies cannot be planned since patients are not aware of their repressed memories. However, it is very important to keep in mind the possibility of surfacing memories when treating fibromyalgia patients with HBOT or other interventions capable of awakening dormant brain regions.
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Affiliation(s)
- Shai Efrati
- Sagol Center for Hyperbaric Medicine and Research, Assaf Harofeh Medical Center, Zerifin, Israel.,Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel.,Sagol School of Neuroscience, Tel Aviv University, Tel Aviv, Israel
| | - Amir Hadanny
- Sagol Center for Hyperbaric Medicine and Research, Assaf Harofeh Medical Center, Zerifin, Israel.,Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Shir Daphna-Tekoah
- Ashkelon Academic College, Ashkelon, Israel.,Social Work Department, Kaplan Medical Center, Rehovot, Israel
| | - Yair Bechor
- Sagol Center for Hyperbaric Medicine and Research, Assaf Harofeh Medical Center, Zerifin, Israel
| | - Kobi Tiberg
- Department of Psychology, Loewenstein Hospital Rehabilitation Center, Raanana, Israel
| | - Nimrod Pik
- Psychiatric Services, Assaf Harofeh Medical Center, Zerifin, Israel
| | - Gil Suzin
- Sagol Center for Hyperbaric Medicine and Research, Assaf Harofeh Medical Center, Zerifin, Israel
| | - Rachel Lev-Wiesel
- The Emili Sagol CAT Research Center, Graduate School of Creative Arts Therapies, University of Haifa, Haifa, Israel
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Kılıç F, Coşkun M, Bozkurt H, Kaya İ, Zoroğlu S. Self-Injury and Suicide Attempt in Relation with Trauma and Dissociation among Adolescents with Dissociative and Non-Dissociative Disorders. Psychiatry Investig 2017; 14:172-178. [PMID: 28326115 PMCID: PMC5355015 DOI: 10.4306/pi.2017.14.2.172] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/05/2016] [Revised: 04/11/2016] [Accepted: 04/20/2016] [Indexed: 11/19/2022] Open
Abstract
OBJECTIVE To explore the role of trauma and dissociation over self-injurious behaviors (SIB) and suicide attempts (SA) in adolescents. METHODS A total of 207 adolescents participated in the study. After conducting diagnostic interview, participants were divided into five groups as subjects with dissociative disorders (DD), attention deficit hyperactivity disorder (ADHD), major depressive disorder (MDD) and anxiety disorders (AD), and a control group (CG) without any psychiatric disorder. ADHD, MDD and AD groups were considered as non-dissociative disorders (non-DD group) in the present study. RESULTS There is no significant difference between groups in terms of number and age of the subjects (p>0.05). Among all participants SIB was reported in 32.2% of females (n=37) and 25% of males (n=23) while SA was reported in 29.6% of females (n=34) and 4.4% of males (n=4). Adolescents with DD were found to experience higher rates of SIB and SA than the other groups. Dissociation was the most important variable contributing to SIB and female gender was the most efficient variable for SA. Total trauma scores were also found to be significantly higher in DD group followed by non-DD and CG respectively. CONCLUSION SIB and SA are complex behavioral problems which may be associated with many psychiatric factors. However higher level dissociation seems as an important mediating factor, even regardless of psychiatric diagnosis, in the development of SIB and SA. More research is needed to further explore the factors effective over SIB and SA in adolescents.
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Affiliation(s)
- Filiz Kılıç
- Department of Child and Adolescent Psychiatry, Faculty of Medicine, Gaziantep University, Gaziantep, Turkey
| | - Murat Coşkun
- Department of Child and Adolescent Psychiatry, Istanbul Medical Faculty, Istanbul University, Istanbul, Turkey
| | - Hasan Bozkurt
- Department of Child and Adolescent Psychiatry, Faculty of Medicine, Gaziosmanpasa University, Tokat, Turkey
| | - İlyas Kaya
- Department of Child and Adolescent Psychiatry, Istanbul Medical Faculty, Istanbul University, Istanbul, Turkey
| | - Salih Zoroğlu
- Department of Child and Adolescent Psychiatry, Istanbul Medical Faculty, Istanbul University, Istanbul, Turkey
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