Emotional Dissociation in Response to Trauma

An Information-Processing Approach
  • Edna B. Foa
  • Diana Hearst-Ikeda


Pathological reactions to trauma and extreme stress have been noted in the psychological literature for over a century. These reactions were codified in the psychiatric literature as posttraumatic stress disorder (PTSD) (American Psychiatric Association, 1980). The diagnosis of PTSD is made when posttrauma symptoms occur in three domains: emotional, cognitive, and visual reexperiencing of the trauma; avoidance of trauma-relevant stimuli; and general arousal. Since the inception of PTSD as a diagnostic entity, experts have focused on the fear and anxiety components of the disorder (Foa, Steketee, & Rothbaum, 1989; Keane, Zimering, & Caddell, 1985). More recently, trauma researchers have become interested in the phenomenon of affective and cognitive avoidance that is commonly observed following a trauma and has been referred to as dissociation (e.g., Spiegel, Hunt, & Dondershine, 1988), denial (Horowitz, 1986; van der Kolk, 1987), or numbing (e.g., Foa, Riggs, & Gershuny, 1995; Horowitz, Wilner, Kaltreider, & Alvarez, 1980; Litz, 1993; van der Kolk & Ducey, 1989). Common to these constructs is a diminished awareness of one’s emotions or thoughts, which is hypothesized to be motivated by self-preservation.


Emotional Processing Posttraumatic Stress Disorder Borderline Personality Disorder Rape Victim Dissociative Experience 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.


Unable to display preview. Download preview PDF.

Unable to display preview. Download preview PDF.


  1. American Psychiatric Association. (1980). Diagnostic and statistical manual of mental disorders (3rd ed.) Washington, DC: Author.Google Scholar
  2. American Psychiatric Association. (1987). Diagnostic and statistical manual of mental disorders (3rd ed., rev.) Washington, DC: Author.Google Scholar
  3. American Psychiatric Association. (1994). Diagnostic and statistical manual of mental disorders ( 4th ed. ). Washington, DC: Author.Google Scholar
  4. Bernstein, E. M.,, Putnam, E. W. (1986). Development, reliability and validity of a dissociation scale. Journal of Nervous and Mental Disease, 174, 727–734.CrossRefGoogle Scholar
  5. Bliss, E. L. (1984). Multiple personalities: A report of 14 cases with implications for schizophrenia and hysteria. Archives of General Psychiatry, 37, 1388–1397.CrossRefGoogle Scholar
  6. Boon, S.,, Draijer, N. (1991). Diagnosing dissociative disorders in the Netherlands: A pilot study with the structured clinical interview for D-III-R dissociative disorders. American Journal of Psychiatry, 148, 458–462.Google Scholar
  7. Boudewyns, P (1975). Implosive therapy and desensitization therapy with inpatients: A five-year follow-up. Journal of Abnormal Psychology, 84, 159–160.PubMedCrossRefGoogle Scholar
  8. Boudewyns, P. A.,, Wilson, A. E. (1972). Implosive therapy and desensitization therapy using free association in the treatment of inpatients. Journal of Abnormal Psychology, 79, 259–268.Google Scholar
  9. Branscombe, L. B. (1991). Dissociation in combat-related post-traumatic stress disorder. Dissociation, 4, 13–20.Google Scholar
  10. Braun, B. G., Sachs, R. G. (1985). The development of multiple personality disorder: Predisposing, precipitating, and perpetuating factors. In R. P. Kluft (Ed.), Childhood Antecedents of Multiple Personality (pp. 37–64 ). Washington, DC: American Psychiatric Press.Google Scholar
  11. Bremner, J. D., Southwick, S., Brett, E., Fontana, A., Rosenheck, R.,, Charney, D. (1992). Dissociation and posttraumatic stress disorder in Vietnam combat veterans. American Journal of Psychiatry, 149, 328–332.Google Scholar
  12. Breuer, J.,, Freud, S. (1985). Studies on hysteria. New York: Basic Books.Google Scholar
  13. Burgess, A. W,, Holmstrom, L. L. (1976). Coping behavior of the rape victim. American Journal of Psychiatry, 133, 413–418.Google Scholar
  14. Cardena, E.,, Spiegel, D (1993). Dissociative reactions to the Bay Area earthquake. American Journal of Psychiatry, 150, 474–478.Google Scholar
  15. Gardena, E., Classen, K.,, Spiegel, D. (1991). Stanford acute stress reaction questionnaire. Stanford, CA: Stanford University Medical School.Google Scholar
  16. Chu, J. A.,, Dill, D. L. (1990). Dissociative symptoms in relation to childhood physical and sexual abuse. American Journal of Psychiatry, 147, 887–892.Google Scholar
  17. Coons, P,, Milstein, V. (1986). Rape and post-traumatic stress in multiple personality. Psychological Reports, 55, 839–845.Google Scholar
  18. Coons, P M., Bowman, E. S., Fellow, T. A.,, Schneider, P. (1989). Post-traumatic aspects of the treatment of victims of sexual abuse and incest. Treatment of Victims of Sexual Abuse, 12, 325–335.Google Scholar
  19. Dancu, C. V., Riggs, D. S., Hearst-Ikeda, D., Shoyer, B., , Foa, E. B. (in press). Dissociative experiences and post-traumatic stress disorder among female victims of criminal assault and rape. Journal of Traumatic Stress. Google Scholar
  20. Davidson, J.,, Foa, E. B. (1991). Diagnostic issues in post-traumatic stress disorder: Consideration for the DSM-IV. Journal of Abnormal Psychology, 100, 346–355.Google Scholar
  21. Davidson, J., Smith, R.,, Kudler, H. (1989). Validity and reliability of the DSM-III criteria for posttraumatic stress disorder: Experience with a structured interview. Journal of Nervous and Mental Disease, 177, 336–341.Google Scholar
  22. Foa, E. B. ( 1993, August). Psychopathology and treatment of PTSD in rape victims. Paper presented at the 101st American Psychological Association Annual Convention, Toronto, Canada.Google Scholar
  23. Foa, E. B.,, Kozak, M. J. (1986). Emotional processing of fear: Exposure to corrective information. Psychological Bulletin, 99, 20–35.Google Scholar
  24. Foa, E. B.,, Kozak, M. J. (1991). Emotional processing: Theory, research and clinical implications for anxiety disorder. In J. Safran, L. S. Greenberg (Eds.), Emotion psychotherapy and change (pp. 21–49 ). New York: Guilford Press.Google Scholar
  25. Foa, E. B.,, Riggs, D. S. (1993). Post-traumatic stress disorder in rape victims. In J. Oldham, M. B. Riba,, A. Tasman (Eds.), American psychiatric press review of psychiatry (Vol. 12, pp. 273–303 ). Washington, DC: American Psychiatric Press.Google Scholar
  26. Foa, E. B., Riggs, D. S., Dancu, C. V,, Rothbaum, B. O. (1993). Reliability and validity of a brief instrument for assessing post-traumatic stress disorder. Journal of Traumatic Stress, 6, 459–473.Google Scholar
  27. Foa, E. B., Riggs, D. S.,, Gershuny, B. (1995). Arousal, numbing, and intrusion: Symptom structure of posttraumatic stress disorder following assault. American Journal of Psychiatry, 152, 116–120.Google Scholar
  28. Foa, E. B., Riggs, D. S., Massie, E. D., ,Yarczower, M. (in press). The impact offear activation and anger on the efficacy of exposure treatment for PTSD. Behavior Therapy. Google Scholar
  29. Foa, E. B., Rothbaum, B. O., Riggs, D. S.,, Murdock, T (1991). A prospective examination of post- traumatic stress disorder in rape victims. Journal of Traumatic Stress, 5, 455–475.Google Scholar
  30. Foa, E. B., Steketee, G.,, Rothbaum, B. O. (1989). Behavioral/cognitive conceptualization of post- traumatic stress disorder. Behavior Therapy, 20, 155–176.Google Scholar
  31. Foa, E. B., Zinbarg, R.,, Rothbaum, B. O. (1992). Uncontrollability and unpredictability in posttraumatic stress disorder. Psychological Bulletin, 112, 218–238.Google Scholar
  32. Freinkel, A., Koopman, C.,, Spiegel, D. (1994). Dissociative symptoms in media eyewitnesses of an execution. American Journal of Psychiatry, 157, 1335–1339.Google Scholar
  33. Freud, S. (1950). Beyond the pleasure principle. In J. Strachey (Ed. and Trans.), Complete psychological works, standard edition. (Vol. 3, pp. 9–11). London: Hogarth Press. (Originally published in 1920.)Google Scholar
  34. Gelinas, D. (1983). The persisting negative effects of incest. Psychiatry, 46, 312–332.PubMedGoogle Scholar
  35. Gunderson, J. G., Kolb, J. E.,, Austin, V. (1982). The diagnostic interview for borderline patients. American Journal of Psychiatry, 138, 896–903.Google Scholar
  36. Herman, J., Perry, J. C.,, van der Kolk, J. B. (1989). Childhood trauma in borderline personality disorder. American Journal of Psychiatry, 146, 490–495.Google Scholar
  37. Hilgard, E. R. (1977). Divided consciousness: Multiple controls in human thoughts and action. New York: Wiley.Google Scholar
  38. Horowitz, M., Wilner, N., Kaltreider, N.,, Alvarez, W. (1980). Signs and symptoms of posttraumatic stress disorders. Archives of General Psychiatry, 37, 85–92.CrossRefGoogle Scholar
  39. Horowitz, M. J. (1986). Stress-response syndromes (2nd ed.). Northvale, NJ: Jason Aronson. Horowitz, M. J., Wilner, N.,, Alvarez, W. (1979). Impact of event scale: A measure of subjective distress. Psychosomatic Medicine, 41, 207–218.Google Scholar
  40. Huska, J. A.,, Weathers, F. W. (1991). Reliability and validity of the dissociative experiences scale in combat-related PTSD. Unpublished manuscript. Boston, MA: Behavioral Sciences Division, National Center for PTSD, Boston DVAMC.Google Scholar
  41. Janet, P (1989). L’Automisme psychologique. Paris: Felix Alcan.Google Scholar
  42. Janet, P. (1907). The major symptoms of hysteria. New York: Macmillian.CrossRefGoogle Scholar
  43. Keane, T. M.,, Kaloupek, D. G. (1985). Imaginal flooding in the treatment of post-traumatic stress disorder. Journal of Consulting and Clinical Psychology, 50, 138–140.Google Scholar
  44. Keane, T. M., Zimering, R. T,, Caddell, J. M. (1985). A behavioral formulation of post-traumatic stress disorder in Vietnam veterans. Behavior Therapist, 8, 9–12.Google Scholar
  45. Keane, T. M., Fairbank, J. A., Caddell, J. M.,, Zimering, R. T. (1989). Implosive (flooding) therapy reduces symptoms of PTSD in Vietnam combat veterans. Behavior Therapy, 20, 245–260.Google Scholar
  46. Kinzie, J. D., Sack, W. H., Angell, R. H., Manson, S.,, Rath, B. (1986). The psychiatric effects of massive trauma on Cambodian children: I. The children. Journal of the American Academy of Child Psychiatry, 25, 370–376.CrossRefGoogle Scholar
  47. Kinzie, J. D., Sack, W. H., Angell, R. H., Clarke, G.,, Rath, B. (1989). A three-year follow-up of Cambodian young people traumatized as children. Journal of the American Academy of Child and Adolescent Psychiatry, 28, 501–504.CrossRefGoogle Scholar
  48. Koopman, C., Classen, C.,, Spiegel, D. (1994). Predictors of post-traumatic stress symptoms among Oakland/Berkeley firestorm survivors. American Journal of Psychiatry, 151, 888–894.Google Scholar
  49. Kozak, M. J., Foa, E. B., Steketee, G.,, Grayson, (1988). Process and outcome of exposure treatment with obsessive-compulsives: Psychophysiological indicators of emotional processing. Behavior Therapy, 19, 157–169.Google Scholar
  50. Lang, P. J. (1977). Imagery in therapy: An information processing analysis of fear. Behavior Therapy, 8, 862–886.CrossRefGoogle Scholar
  51. Lang, P. (1979). A bio-informational theory of emotional imagery. Psychophysiology, 16, 495–512. Lang, P, Melamed, B.,, Hart, J. D. (1970). A psychophysiological analysis of fear modification using automated desensitization. Journal of Abnormal Psychology, 31, 220–234.Google Scholar
  52. Lindemann, E. (1944). Symptomatology and management of acute grief. American Journal of Psychiatry, 101, 141–148.Google Scholar
  53. Litz, B. T. (1993). Emotional numbing in combat-related post-traumatic stress disorder: A critical review and reformulation. Clinical Psychology Review, 12, 417–432.CrossRefGoogle Scholar
  54. Madakasira, S.,, O’Brien, K. (1987). Acute posttraumatic stress disorder in victims of natural disaster. Journal of Nervous and Mental Disorders, 175, 286–290.CrossRefGoogle Scholar
  55. Marmar, C. R.,, Weiss, D. S. (1990). Peritraumatic dissociative experiences questionnaire-subject version. Unpublished scale. San Francisco, CA: San Francisco Medical School.Google Scholar
  56. Marmar, C. R., Weiss, D. S., Schlenger, W. E., Fairbank, J. A., Jordan, B. K., Kulka, R,. A.,, Hough, R. L. (1994). Peritraumatic dissociation and post-traumatic stress in male Vietnam theatre veterans. American Journal of Psychiatry, 151, 902–907.Google Scholar
  57. McFarlane, A. C. (1986). Posttraumatic morbidity of a disaster: A study of cases presenting for psychiatric treatment. Journal of Nervous and Mental Disease, 174, 4–14.PubMedCrossRefGoogle Scholar
  58. Nemiah, J. (1981). Dissociation disorders. In A. M. Freeman, H. I. Kaplan (Eds.), Comprehensive textbook of psychiatry. ( 3rd ed., pp. 1554–1561 ). Baltimore: Williams, Wilkins.Google Scholar
  59. Noyes, Jr., R.,, Kletti, R. (1977). Depersonalization in the face of life-threatening danger: A description. Psychiatry, 39, 19–27.Google Scholar
  60. Noyes, Jr., R., Hoenk, P. R., Kuperman, S.,, Slymen, D. J. (1977). Depersonalization in accident victims and psychiatric patients. Journal of Nervous Disorder and Mental Disease, 164, 401–407.CrossRefGoogle Scholar
  61. Ogata, S. N., Silk, K. R., Goodrich, S., Lohr, N., Westen, D.,, Hill, E. M. (1990) Childhood sexual and physical abuse in adult patients with borderline personality disorder. American Journal ofPsychiatry, 147, 1008–1013.Google Scholar
  62. Orr, W. (1991). Psychophysiological studies of posttraumatic stress disorder. In E. L. Giller, Jr. (Ed.), Biological assessment and treatment of posttraumatic stress disorder (pp. 135–157 ). Washington, DC: American Psychiatric Press.Google Scholar
  63. Orr, S. P., Claiborn, J. M., Altman, B., Forgue, D. E, De Jong, J. B., Pitman, R. K.,, Herz, L. R. (1990). Psychometric profile of posttraumatic stress disorder, anxiety, and healthy Vietnam veterans: Correlations with psychophysiologie responses. Journal of Consulting and Clinical Psychology, 58, 329–335.Google Scholar
  64. Pitman, R., van der Kolk, B., Orr, S.,, Greenberg, L. (1990). Nalaxone-reversible analgesic response to combat-related stimuli in posttraumatic stress disorder: A pilot study. Archives of General Psychiatry, 47, 541–544.Google Scholar
  65. Putnam, F. W. (1989). Diagnosis and treatment of multiple personality disorder. New York: Guilford Press.Google Scholar
  66. Rachman, S. (1980). Emotional processing. Behaviour Research and Therapy, 18, 51–60.PubMedCrossRefGoogle Scholar
  67. Riggs, D. S., Dancu, C. V, Gershuny, B. S., Greenberg, D.,, Foa, E. B. (1992). Anger and post-traumatic stress disorder in female crime victims.Journal of Traumatic Stress, 5, 613–625.Google Scholar
  68. Roca, R. P, Spence, R. J.,, Munster, A. (1992). Posttraumatic adaptation and distress among adult burn survivors. American Journal of Psychiatry, 149, 1234–1238.Google Scholar
  69. Ross, C. A., Heber, S., Norton, G. R., Anderson, D., Anderson, G.,, Barchet, (1989). The dissociative disorders interview schedule: A structured interview. Dissociation: Progress in the Dissociative Disorders, 2(3), 169–189.Google Scholar
  70. Rothbaum, B. O., Foa, E. B., Riggs, D. S., Murdock, T,, Walsh, W. (1992). A prospective examination of post-traumatic stress disorder in rape victims. Journal of Traumatic Stress, 5, 455–475.Google Scholar
  71. Sanders, B. (1986). The perceptual alterations scale: A scale measuring dissociation. American Journal of Clinical Hypnosis, 29, 95–102.CrossRefGoogle Scholar
  72. Sanders, B.,, Giolas, M. H. (1991). Dissociation and childhood trauma in psychological disturbed adolescents. American Journal of Psychiatry, 148, 50–54.Google Scholar
  73. Sanders, B., McRoberts, G.,, Tollefson, C. (1989). Childhood stress and dissociative in a college population. Dissociation, 2, 17–23.Google Scholar
  74. Silver, S.,, Iacano, C. (1984). Factor analytic support for DSM-III post traumatic stress disorder for Vietnam veterans. Journal of Clinical Psychology, 40, 5–14.Google Scholar
  75. Solomon, Z.,, Mikulincer, M. (1992). Aftermaths of combat stress reactions: A three year study. British Journal of Clinical Psychology, 31, 21–32.Google Scholar
  76. Solomon, Z., Mikulincer, M.,, Benbenishty, B. (1989). Combat stress reaction: Clinical manifestations and correlates. Military Psychology, 1, 35–47.CrossRefGoogle Scholar
  77. Siegel, R. K. (1984). Hostage hallucinations. Journal of Nervous and Mental Disorders, 172, 264–272.CrossRefGoogle Scholar
  78. Spiegel, D. (1986). Dissociating damage. American Journal of Clinical Hypnosis, 29, 123–131.PubMedCrossRefGoogle Scholar
  79. Spiegel, D.,, Cardena, E. (1990). dissociative mechanisms in posttraumatic stress disorder. In M. E. Wolf, A. D. Mosnian (Eds.), Posttraumatic stress disorder: Etiology, phenomenology, and treatment (pp. 23–34 ). Washington, DC: American Psychiatric Press.Google Scholar
  80. Spiegel, D., Hunt, T,, Dondershine, H. E. (1988). Dissociation and hypnotizability in posttraumatic stress disorder. American Journal of Psychiatry, 145, 310–305.Google Scholar
  81. Spiegel, H. (1963). The dissociation-association continuum. Journal of Nervous and Mental Disorders, 136, 374–378.CrossRefGoogle Scholar
  82. Terr, L. C. (1991). Childhood trauma: An outline and overview. American Journal of Psychiatry, 148, 10–16.PubMedGoogle Scholar
  83. Kolk, B. (1987). Psychological trauma. Washington, DC: American Psychiatric Press.Google Scholar
  84. Kolk, B.,, Ducey, C. P. (1989). The psychological processing of traumatic experiences and Rorschach patterns in PTSD. Journal of Traumatic Stress, 2, 259–274.CrossRefGoogle Scholar
  85. Waid, L. R.,, Urbanczyk, S. A. (1989, August). A comparison of high versus low dissociative Vietnam veterans with PTSD. Poster presented at the Annual Meeting of the American Psychological Association, New Orleans.Google Scholar
  86. Wilkinson, C. B. (1983). Aftermath of a disaster: The collapse of the Hyatt Regency Hotel skywalk. American Journal of Psychiatry, 140, 1134–1139.PubMedGoogle Scholar
  87. Zimering, R. T, Caddell, J. M., Fairbank, J. A.,, Keane, T. M. (1993). Posttraumatic stress disorder in Vietnam veterans: An experimental validation of the DSM-III diagnostic criteria. Journal of Traumatic Stress, 6, 327–342.Google Scholar

Copyright information

© Springer Science+Business Media New York 1996

Authors and Affiliations

  • Edna B. Foa
    • 1
  • Diana Hearst-Ikeda
    • 2
  1. 1.Center for the Treatment and Study of AnxietyMedical College of Pennsylvania, Eastern Pennsylvania Psychiatric InstitutePhiladelphiaUSA
  2. 2.National Center for Posttraumatic Stress Disorder, Women’s Health and Sciences DivisionBoston Department of Veterans Affairs Medical CenterBostonUSA

Personalised recommendations