There is little debate regarding the existence of dissociation, particularly following overwhelming traumatic events. It often represents a normal response but in some individuals is problematic. Indeed, peritraumatic dissociation has been strongly associated with the development of post-traumatic stress disorder. Dissociative disorders, with their often bizarre, intriguing and illogical presentations, have provoked more disagreement amongst professionals, a particular example being discourse over the existence and prevalence of dissociative identity disorder.
Vermetten, Dorahy & Spiegel have brought together a group of experts in this field to produce a very readable volume that provides a comprehensive overview of the current knowledge base, largely from the viewpoint of individuals who strongly believe in the concepts they discuss. Several chapters do an excellent job in objectively reviewing the evidence and not shying away from the scepticism they recognise is present among some individuals. Lowenstein, in his chapter on dissociative identity disorder, argues the case of apparent double standards when assessing the research evidence collected in studies of dissociative identity disorder when compared with that of other disorders and cogently argues that a body of research data has been entirely discounted.
The book is separated into three parts. The first considers the conceptual domain of dissociation, covering the history of it as a concept and its relationship with trauma and post-traumatic stress disorder, along with the contribution of attachment theory. The second part provides an excellent review of work concerning the neurobiology of trauma and dissociation. Perhaps not surprisingly the first two parts raise more questions than they answer but certainly demonstrate that a considerable amount of well-designed work has been done in the area of traumatic dissociation and that there is a need for more.
The final part discusses contemporary implications for assessment and treatment. Most of the chapters provide helpful, practical tips for clinicians to manage some of the most complex patients they are likely to encounter. Chu's final chapter on the treatment of traumatic dissociation is a fitting end to the book. He advocates a cautious, pragmatic approach to patients with traumatic dissociation, arguing for the building of coping skills before attempts to explore and work through traumatic experiences. He importantly comments that ‘excessive fascination or preoccupation with dissociative phenomenology’ can adversely impact on outcome.
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