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In the wake of traumatic experience, survivors tend to be overwhelmed by intense emotions and body sensations, loss of faith in the universe, and unrelenting punitive introspection. Addictive craving and behavior seem to offer an ‘out,’ the promise of blessed relief from both the emotional and somatic overwhelm. The result is the frequent co-occurrence of addictive disorders that ultimately poses an equal or even greater threat to the patient as do the trauma symptoms.
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Dr. Brand will describe ways to manage common assessment challenges such as mistrust, amnesia and conflicting and variable experiences of symptoms. She will review the behaviors exhibited by DD patients during psychological assessment, describe a method for obtaining valid assessment data from them, and review some of the trauma-specific tests (DES, TSI, MID, MDI) and interviews (SCID-D-R, DDIS) that are useful in making a differential diagnosis of DD for adults.
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This workshop will provide an overview of the research on DD patients’ profiles on personality inventories (MMPI/MMPI-2, MCMI-II/MCMI-III) and projectives (Rorschach, Rotter Incomplete sentences, TAT). Dr. Brand will focus on how these tests can be useful in making differential diagnoses. She will review ways to clarify if the high levels of symptomatology seen in clients with DD are due to exaggerating and/or feigning symptomatology, including using an interview that assesses feigning of psychiatric disorders (SIRS).
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When chronic traumatization occurs, inner experience (emotions, needs, thoughts, fantasies, desires, bodily feelings, etc.) can become frightening, shame-inducing, and baffling aspects of the survivor’s world. The physical sensations, impulses, gestures and actions that correspond to such inner experience may also be a source of fear, shame and confusion.
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Mentalizing is the process by which we make sense of the contents of our own minds and that of others. Requiring an optimal level of arousal as well as a nurturing and safe attachment relationship to develop, mentalizing is conspicuously impaired and even frightening for patients who have suffered attachment trauma. Mentalizing requires the capacity to be present, to accurately read relational cues, and to be mindful and tolerant of one’s own inner experiences.
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To recognize dissociative process in your patients requires a shift in the clinician’s attention to take in not only the foreground specificity of what the patient says and does but to add the much more diffuse and somewhat vague background presentation of “how the patient is and how they communicate” what they are trying to convey and not convey.
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Abstract
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Disorganized attachment processes have been theorized to contribute to a range of trauma-related psychopathologies in adulthood. Dr. Lyons-Ruth will focus on the current state of knowledge regarding parent-child interaction patterns associated with trajectories toward dissociation, borderline psychopathology, and suicidality, and present new interactional and neurobiological findings from recent longitudinal work.
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