Theories Of Dissociation

In recent years, there has been a growing interest amongst researchers and clinicians on developing working knowledge of dissociation (Bucci, 2011; Binks & Fergusson, 2013). Dissociation is a reaction to trauma and has been described as a typical defence mechanism to repeated stressful or traumatic situations (Brand, McClary, Myrick, Loewenstein, Classen, Lanius, McNary, Pain & Putnam, 2012a; Brand, Myrick, Loewenstein, Classen, Lanius, McNary, Pain & Putnam, 2012b). Severe isolated traumas or repeated traumas may result in a person developing a dissociative disorder. A dissociative disorder impairs the normal state of awareness and limits or alters one’s sense of identity, memory or consciousness. Recent research indicates that dissociative

symptoms are as common as anxiety and depression, and that individuals with dissociative disorders, particularly Dissociative Identity Disorder often misdiagnosed for many years, delaying effective treatment (Liotti, 2006; Sternberg, 2008). Brand et al (2012a; 2012b) note that patients with Dissociative Identity Disorder often seek treatment for a variety of other problems including depression, difficulty concentrating, memory lapses, alcohol or drug abuse, temper outbursts, psychotic symptoms, physical ailments and memory problems. Thus, patients are left undiagnosed for a considerable length of time after presenting to mental health services (ISSTD, 2011).
Studies have found that different kinds of events or life experiences are likely to cause symptoms of dissociation.

These include emotional, physical or sexual abuse, natural disasters, political traumas, wars or bereavement (Brand et al, 2012a;2012b). There is contention about the aetiology of dissociative disorders. Whilst some researchers posit that it has its origin form unresolved long-term exposure to traumatic experiences (Bucci, 2011), some researchers take a social learning point of view, opining that the disorder is the result of clinicians who impose their views on patients ( ). (Bucci (2011), exploring the neuroscience of dissociation suggests that there are two forms of dissociation – primary and secondary dissociation. Primary dissociation occurs when the regulation of behavioural response to threat is disrupted so that the system remains in emergency mode with potentially damaging effect on bodily systems. He also suggests that in secondary dissociation, the direct physiological effects are less acute than in primary dissociation but the encoding of events is impaired because of their specific meanings (Bucci,

2011).
1. Rationale
The impetus for the current review was borne out of the first author’s developing knowledge of dissociation. This knowledge has been derived from training and clinical experience which has stirred her interest in understanding more about how psychological therapists work with dissociation. Furthermore, the review aims to encapsulate the literature on dissociative disorders in order to provide a synthesis of its development and clinical application. It is envisaged that this would be relevant for clinical, policy-making and contribute to knowledge of areas for further research.
2. Research question
The research question is “What is known from the existing literature about dissociation, its prevalence in clinical populations and what therapy approach psychological therapists use in working with it?” Specifically, the review would aim to explore:
• How the understanding of dissociation has evolved?
• What is the prevalence rate of dissociation in clinical populations
• How different theoretical perspectives define and explain dissociation?
• What approaches psychological therapists use to work with dissociation?

3. Material and Methods
Grant and Booth (2011) carried out a scoping review of the different forms of literature review. They identified the strengths and weaknesses of 14 different forms of reviews. For this study, a narrative review is more appropriate than other forms of review (for example, scoping and systematic) as the field of dissociation is broad and there are diverse approaches used to understand it. Furthermore, a narrative review allows for a bringing together of the diverse published literature on dissociation (Beaumont & Hollins Martin, 2015).
Initial findings from studies indicate that psychological therapists utilise an eclectic approach to working with dissociation.

A narrative review of the literature therefore offers a means of exploring wider relevant literature in the field of dissociation. This allows for the broad findings from research to be explored.
4. Ethical Considerations
The authors have not needed ethical approval to carry out this study as only published data that were in public domain were used. However, certain ethical considerations have been adhered to. Wager and Wiffen (2011) identified some ethical considerations authors of literature reviews need to adhere to. Whilst their primary focus was on authors writing systematic review for Cochrane journals, the suggestions are applicable to all authors of any form of literature review. The six suggestions are as follows:
1. Guidance on authorship: The primary author of the current review is the first author. She has been guided and supported by her research supervisors. As they have contributed to the writing by offering suggestions and guidance on the study, their contribution has been acknowledged by identifying them as

co-authors.
2. Avoiding redundant/duplicate publications: The authors have been careful to ensure that no study is superfluous. Where authors have written more than one studies, these are accurately represented by stating dates of publications.
3. Avoiding plagiarism: The authors have been careful to acknowledge all sources. The current review is an original narrative review of the field of dissociation.
4. Transparency: The authors have taken and impartial and objective stance in review of the literature. Bias is not given to any source or findings.
5. Ensuring accuracy: Findings are accurately explored and the review offers an unbiased representation of findings and results.
6. Flashing suspected Plagiarism: The authors not only commit to avoiding plagiarism. The current review also aims to note any plagiarism in any of the studies explored.

5. Search Strategy
In carrying out the current review of the field of dissociation, a comprehensive primary and secondary literature (published and unpublished) suitable for answering the research questions were identified. To achieve this, the search strategy employed, involved searching for research evidence through multiple sources: These include electronic databases like google scholar, Psychology and Behavioral