#scid-d

Dissociation is the mind's way of coping with overwhelming stress and trauma. Facing what it perceives as a life-threatening situation, the mind disconnects from its immediate surroundings, compartmentalizing authentic feelings—like despair or terror—that may hinder survival. At some point in their lives, to some degree, most people have experienced dissociation. For instance, following a car accident or the death of a loved one, you might feel emotionally numb or disconnected. This transient dissociation usually isn't problematic. But when due to trauma that's severe or ongoing, dissociation can cause considerable distress and/or difficulty functioning. Children, adolescents, and adults exposed to attachment traumas, neglect, or abuse, as well as combat veterans and survivors of sexual assault, are all at risk for developing recurrent dissociation-with the attendant and abiding feelings of inner fragmentation, self-alienation, shame, and fear. It is important to note that trauma encompasses more than might come to mind at first. For example, in addition to physical or sexual abuse, underrecognized traumas, such as chronic childhood invalidation, vicarious trauma, or intergenerational trauma, can also contribute to the development of dissociation.

Over the last few decades, societal consciousness has come to recognize the high prevalence of trauma in the public.[1] A study by the National Survey of Children's Health found that almost 50% of children under the age of 17 in the United States have experienced at least one significant trauma (The Child and Adolescent Health Measurement Initiative 2017-2018). What's more, a growing number of clinicians have endorsed therapy models predicated upon multiple aspects of self[2], suggesting the wide prevalence of inner fragmentation typical of persons who have suffered trauma. Still, very few survivors ever learn that what they're suffering from is called dissociation, despite the fact that it underlies all posttraumatic conditions. Simply put, "all trauma-related disorders (i.e., Acute Stress Disorder, PTSD, and Dissociative Disorders) share a common central psychobiological pathology that is dissociative" (Van der Hart, Nijenhuis, and Steele 2005).

[1]: Dr. Vedat Sar reviewed an extensive body of epidemiological research to investigate the prevalence of dissociative disorders. Typically correlated with childhood abuse and other traumas, dissociative disorders, Sar concludes, "constitute a hidden and neglected public health problem," with around 10% of clinical populations, and 0.4%-3% of the general population, suffering from Dissociative Identity Disorder (DID) (Sar 2011). (Prevalence is even higher when all dissociative conditions, not just DID, are considered. For more information, see Johnson, Cohen, Kasen, and Brook 2006, a major epidemiological study of dissociative disorders in the community.) [2]: Such models include Compassion-Focused Therapy, Ego State Therapy, Internal Family Systems Therapy, Phase Oriented Trauma and Dissociation Informed Treatment, Structural Dissociation, and other integrative models (Brown and Eliot 2016; Fine 1996; Fisher 2017; Gilbert 2010; Herman 2015; Howell 2020; International Society for the Study of Trauma and Dissociation 2005; Kluft 1993; Kluft, Bloom, and Kinzie 2000; Perry and Dobson 2013; Schwartz 2001; Siegel 2020; Sinason 2010; Steele, Van der Hart, and Nijenbuis 2005; Van der Hart, Nijenhuis, and Steele 2006; Watkins and Watkins 1997).

The connection between posttraumatic stress disorder (PTSD) and dissociation deserves emphasis, with empirical research illuminating a robust correlation.[3] In recognition of the prevalence of a limited subset of dissociative symptoms (specifically depersonalization and derealization) in people suffering from PTSD, DSM-5 added a dissociative subtype of PTSD, marking a watershed moment in the PTSD field's understanding of these afflictions (American Psychiatric Association 2013). Recent studies have noted a significant percentage of persons with PTSD with histories of childhood and/or adult trauma met criteria for the dissociative subtype, ranging from 54% to 83% (Hill, Wolff, Bigony et al. 2019; Swart, Wildschut, Draijer et al. 2020).

[3]: For studies relevant to dissociation in trauma survivors, see Carlson, Dalenberg, and McDade-Montez 2012; Lyssenko, Schmahl, and Bockhacker 2018; Spiegel and Cardena 1990; Wolf, Lunney, Miller et al. 2012).

There is a growing body of empirical evidence indicating that many PTSD sufferers experience a range of dissociative symptoms beyond depersonalization or derealization, and that the new dissociative subtype of PTSD may understate dissociation's role in PTSD. Studies that evaluated the full range of dissociative symptoms found that 34%-87% of people suffering from PTSD met the criteria for a dissociative disorder, many with dissociative conditions beyond what is detectable using diagnostic tools for the dissociative subtype of PTSD (Darves-Bomoz 1997; Darves-Bomoz, Degiovanni, and Gaillard 1995; Darves-Bomoz, Berger, Degiovanni et al. 1999; Roca, Hart, Kimbrell 2006). Vietnam veterans diagnosed with PTSD were found not only to suffer from the full range and severity of dissociative symptoms but also to have dissociative symptom severity scores that were virtually identical to those of persons suffering from complex dissociative disorders (Bremner, Steinberg, Southwick et al. 1993). In light of this research, some experts have asserted that "dissociation is characteristic of all PTSD" (Dorahy and Van der Hart 2015). Elizabeth Howell speaks for a growing number of experts in boldly defining trauma as "that which causes dissociation" (Howell 2020).

When someone suffers from dissociation, it is not usually their presenting complaint. Extensive research indicates that people suffering from dissociation seek treatment for depression, anxiety, mood swings, hearing voices, attention problems, obsessive-compulsive symptoms, addictions, self-destructive behavior, and somatic symptoms—essentially everything but dissociation (Bailey, Boyer, Brand 2019; Bakim, Baran, Diyaddin et al. 2016; Bowman 2006; Coons 1984; Coons, Bowman, Milstein 1988; Goff, Jenilee, Baer et al. 1992; Haugen and Castillo 1999; Karadag, Sar, Tamar-Gurol et al. 2005; Kluft 1985, 1987; Nijenhuis 2000; Putnam, Guroff, Silberman et al. 1986; Sar 2011; Sar, Kundakçi, Kiziltan et al. 2003; Somer, Altusa, and Ginzburg 2010; Steinberg 1995; Steinberg and Schnall 2010; Steinberg, Barry, Sholomskas et al. 2005; Tanner, Wyss, Perron et al. 2017). Yet optimal care depends on accurate diagnosis. For decades, lack of a reliable methodology for diagnosing dissociation led to misdiagnosis, ineffective treatment, and unnecessary suffering, sometimes lasting as many as fifty years. Before that diagnostic methodology could be developed, however, the symptoms of the underlying dissociative condition had to be understood. While eminent theorists such as Janet and Prince explored dissociation in case studies more than a century old (Janet 1907; Prince 1925), only over the last thirty-five years have the basic components of this ubiquitous defense mechanism been examined systematically and clarified on the basis of large-scale, replicable investigations. Until then, lack of empirical research led some psychiatrists to wonder whether dissociative identity disorder, the most complex of those disorders, was a genuine condition, or even iatrogenic (Brand, Sar, Stavropoulos et al. 2016; Loewenstein 2018). And when doctors did accept the disorder's reality, diagnostic methods varied in sensitivity, with missed cases of dissociative identity disorder risking decompensation due to the lack of trauma-informed treatment.

I still remember, when I was in training, witnessing a woman named Gloria in the psychiatric in-patient unit receive sodium amobarbital (Amytal), a sedative meant to allow her alternate personalities to emerge, which, if present, would facilitate diagnosis of what was then known as Multiple Personality Disorder. Before our eyes, Gloria switched to a tearful adolescent alter who complained in a high, girlish voice about the hopelessness of her life. Suddenly she switched to an even more childish alter who babbled about the "bad booboos that Mommy and Daddy did." There was no doubt that Gloria was suffering from a dissociative disorder and needed treatment. But later, when I asked about her, I learned that she'd fled the hospital the next day after the Amytal had made her alters surface before a group of wide-eyed residents—including me. Humiliated, Gloria had bolted. I could understand why. Regret for the insensitivity she had suffered under the rubric of "training" turned this into a defining moment for me.

When I made it my mission to study dissociation, however, I encountered resistance. After completing my residency, I went to see a well-respected expert in psychiatry to inquire about my research options. As I told him about my plan to study dissociation, he listened with an inscrutable expression. I finished, and e cocked an eyebrow at me quizzically. He paused for a long moment. Then he said, as tactfully as he could, "Marlene, I would advise you that if you're interested in a successful career in research, find another subject."

Nevertheless, I persisted. Four years later, in 1989, I was awarded the first of two substantial grants from the National Institute of Mental Health, the first ever given to a researcher in dissociation. These grants allowed me to further refine my Five Component Model for Dissociation Assessment and conduct field trials of the Structured Clinical Interview for DSM-III-R Dissociative Disorders—the SCID-D, for short—the specialized interview I'd developed to meet the need for reliable dissociative symptom and disorder diagnosis. Over the course of the field trials, over three hundred interviews were conducted by ten clinicians, producing over one thousand hours of videotaped interviews. Those tapes were then reviewed; the data were analyzed to identify and validate the salient features that distinguished those who were suffering from a dissociative disorder from those who weren't. When we studied the results, it became clear that the clinicians' independent assessments almost always agreed, establishing high inter-rater reliability for the SCID-D. Finally, in 1993, the SCID-D and Interviewer's Guide were published for widespread use (Steinberg 1993a, 19936). Since then, the interview has been administered with adolescents as young as eleven, and adults, in French, Gennan, Hebrew, Korean, Turkish, Dutch, Nmwegian, Spanish, Filipino, Danish, Persian, and more. Decades of intemational research and clinical experience have replicated our findings and established the SCID-D's reputation as the "gold standard" of dissociation assessment (Aquarone 2022; Boon and Draijer 1991, 1993; Carrion and Steiner 2000; Chang, Chang, Shiah, and Huang 2005; Friedl and Draijer 2000; Gast, Rodewald, and Nickel 200 I; Gingrich 2004; Jepsen, Langeland, Sexton et al. 2014; Kim, Kim, and Jung 2016; Knudsen, Draijer, Haselrud, et al. 1995; Kundakçi, Sar, Kiziltan et al. 2014; Mohajerin, Lynn, Bakhtiyari et al. 2020; Mueller-Pfeiffer, Rufibach, and Wyss 2013; Mychai.lyszyn,Brand, Webermann et al. 2020; Piedfort-Marin, Tarquinio, Steinberg et al. 2021; Rodewald 2005; Sar, Onder, Kilicaslan et al. 2014; Steinberg 1995, 2000; Steinberg and Steinberg 1995; Steinberg, Cicchetti, Buchanan et al. 1994; Steinberg, Rounsaville, and Cicchetti 1990, 1991; Welburn, Fraser, Jordan et al. 2003).

Although theoretical models of dissociation existed, a practical model for clinical assessment was lacking. The SCID-D implements the Five Component Model of Dissociation Assessment and fills this need. As I define it for the purpose of clinical assessment, dissociation can be characterized by five primary components: amnesia, depersonalization, derealization, identity confusion, and identity alteration.[4] While I created the following definitions for "amnesia," "identity confusion," and "identity alteration," the definitions for "depersonalization" and "derealization" were synthesized from the literature.

Amnesia refers to a subjective sense of gaps in one's memory for autobiographical information or experiences, or for blocks of time that have passed, where such lapses cannot be attributed to ordinary forgetfulness.

Depersonalization refers to a feeling of disconnection from oneself (e.g., from one's feelings, thoughts, behavior, or body), or a sense of being an outside observer of one's self.

Derealization refers to a feeling of disconnection from one's surroundings (e.g., people or surroundings feel as if they are unfamiliar, unreal, or distorted).

Identity confusion refers to subjective feelings of uncertainty, puzzlement, conflict, or struggle regarding one's own identity or sense of self.

Identity alteration refers to observable behavior associated with alterations or shifts in one's identity or personality states.

[4]: Though the terms "symptom" and "component" may appear to be used interchangeably throughout the text, there is a subtle distinction. Recently, I introduced the term "component" to depathologize each dissociative experience—amnesia, depersonalization, derealization, identity confusion, and identity alteration—associated with dissociation. Additionally, I use the term to emphasize that such behaviors occur along a spectrum of severity, defined by the SCID-D assessment model's severity rating definitions. Dissociative behaviors that cause distress or compromise functioning are labeled "symptomatic," since the term connotes illness or a condition. Behaviors that don't compromise functioning or cause distress are referred to more neutrally as "components."

Identifying the five primary components of dissociation, developing their standard definitions, and using a standardized method to rate their severity are three major innovations in the SCID-D's assessment of dissociation.

In what sense are these components primary? Just as all other colors can be obtained by mixing the primary colors—red, yellow, and blue—so all posttraumatic dissociative experiences can be understood as consisting of a mixture of these five components. As with a primary color, the intensity of each component varies along a spectrum. On the one end, each can be a normative, transient coping mechanism that does not cause dysfunction or distress. On the other end, each can be recurrent or ongoing, interfering with relationships, causing internal suffering, or otherwise impairing functioning.

Consider flashbacks, a common dissociative experience. What mixture of these components constitutes a flashback? People who experience traumatic flashbacks, including rape survivors and veterans with PTSD, at the time feel disconnected from their current surroundings (derealization), behave as they would have at the time of the trauma (identity alteration), and have memory lapses for events happening around them in the present (amnesia). Another common dissociative behavior is sleepwalking. An individual who sleepwalks has no recollection of their sleepwalking activities (amnesia) and may behave very differently from how they usually would (identity alteration). All other dissociative experiences can be composed in this way using the five primary components as building blocks. Similarly, specific dissociative disorders can also be characterized by their various combinations of the five components-for instance, a moderate-to-severe level of amnesia with none-to-mild levels of the other four symptoms characterizes a diagnosis of Dissociative Amnesia, whereas moderate-to-severe levels of four or five components characterize Dissociative Identity Disorder.

Too frequently, systematic assessment for dissociative processes is overlooked, and the external signs of dissociation (e.g., intrusive thoughts, mood swings, somatization) are not linked to underlying dissociative conditions. The failure to detect dissociation can lead to ineffective treatment, higher rates of hospitalization and suicide attempts, and generally prolonged suffering (Brand, Classen, McNary et al. 2009; Foote, Smolin, and Neft 2008; Kluft 1985, 1987; Mueller, Moergeli, Assaloni et al. 2007; Mueller-Pfeiffer, Rufibach, Perron et al. 2012; Sar, Koyuncu, Ozturk et al. 2007; Tanner, Wyss, Perron et al. 2017; Zoroglu, Tuzun, and Sar 2003). The SCID-D allows clinicians to uncover this connection. By inquiring about the core components of dissociation, the interview gathers the information necessary to look beyond the outermost signs-like depression, anxiety, mood swings, and flashbacks-to establish whether the underlying ailment is dissociative. Like the radiologist's X-ray, the SCID-D reveals the internal structure of dissociation, thereby suggesting a roadmap for effective dissociation-informed treatment.

ln the decades since the SCID-D was first published, research has established the interview's diagnostic accuracy across diverse cultures; the five components present universally in trauma survivors. Numerous investigators have also confirmed the SCID-D's good-to-excellent inter-rater reliability and discriminant validity (Boon and Draijer 1991, 1993; Chang, Chang, Shiah et al. 2005; Friedl and Draijer 2000; Gingrich 2004; Jepsen, Langeland, Sexton et al. 2014; Kim, Kim, and Jung 2016; Knudsen, Draijer, Haselrud, et al. 1995; Kundakçi, Sar, Kjziltan et al. 2014; Mobajerin, Lynn, Bakhtiyari et al. 2020; Piedfort-Marin, Tarquinio, Steinberg et al. 2021; Rodewald 2005; Sar, Onder, Kilicaslan et al. 2014; Steinberg 1995, 2000; Steinberg, Cicchetti, and Buchanan 1994; Steinberg, Rounsaville, and Cicchetti 1990, 1991; Welburn, Fraser, Jordan et al. 2003). A recent meta-analysis of fifteen studies overwhelmingly confirmed the interview's ability to identify individuals with dissociative disorders and distinguish them from other psychiatric disorders and controls (Mychailyszn, Brand, Webennan et al. 2020).

Furthermore, neuroimaging studies have confirmed that people diagnosed with Dissociative Identity Disorder (DID) using the SCID-D interview exhibit unique physiological reactions and cerebral blood flow patterns during identity shifts compared with control subjects, high fantasizers, or actors asked to simulate a shift (Reinders, Willemsen, Vos et al. 2012). These results demonstrate that DID is neither fantasy proneness nor role playing; the brain images simply cannot be simulated. Few diagnostic interviews in psychiatry have demonstrated such diagnostically discriminating findings confirmed by brain imaging studies.

Over the last twenty years, a growing number of studies have also investigated the neuroimaging biomarkers of dissociative disorders. Though findings have not always been consistent, studies of SCID-D-identified individuals with DID suggest that the indicators of dissociation include decreased volume in key brain regions related to memory and executive functioning, similar to the brain patterns displayed by those diagnosed with PTSD (Chalavi, Vissia, Giesen et al. 2015; Logue, van Rooij, Dennis et al. 2018; Roydeva and Reinders 2020). Furthermore, smaller hippocampal volumes were found to be significantly correlated with severe childhood trauma, as well as with increased dissociative symptoms in DID and PTSD (Chalavi, Vissia, Giesen et al. 2015; Dimitrova, Dean, Schlumpf et al. 2021). Research remains to be done to characterize the biomarkers associated with PTSD, its dissociative subtypes, and dissociative disorders generally—but all in all, over two hundred recent investigations have laid the groundwork for understanding the neuroscience of dissociation (Roydeva and Reinders 2020).

When I was developing the SCID-D, my intention was to make visible the hidden components of dissociation. By devising a practical framework and systematic method of inquiry, I hoped to enable detailed assessment of a person's inner world of dissociative experiences and provide clients and therapists with a language for symptoms previously unspoken. That was my original mission. Now, over three decades of use have revealed that, besides serving as a powerful assessment tool, the SCID-D also provides therapeutic benefits (Fisher 2017; Finn and Martin 2013; Finn, Fischer, and Handler 2012; Kluft 2015; Steinberg and Hall 1997). Unlike many psychological tests whose main goal is to gather diagnostic information, the SCID-D poses open-ended questions designed to elicit rich, clinically meaningful information about an individual's subjective sense of their experiences. The chance to discuss, in a nonjudgemental setting, previously hidden or misunderstood experiences can enhance the therapeutic alliance and promote valuable insights. Making space for the individual to develop a more coherent narrative about their dissociative experiences constitutes one of the interview's principal benefits. Lastly, it should be noted that the SCID-D offers therapeutic benefits precisely because it does not pathologize these normal human experiences. For this reason, the information elicited during the interview can be used during feedback and in therapy to validate, educate, and empower.

Since the SCID-D's first use in 1983, it's been gratifying to see increased interest and advances in the field of dissociation. Mental health professionals in specialty clinics, private practices, and forensic settings have used the interview for systematic assessment and client education and as a practical method of inquiry that can enhance treatment. And researchers worldwide have used it to study dissociation and its impact among all posttraumatic conditions, about which we still have so much to learn. This revised edition, informed by over thirty-five years of research and clinical experience, incorporates the following updates:

The title has been changed to The SCID-D Interview: Dissociation Assessment in Therapy, Forensics, and Research to highlight, in addition to its diagnostic value, the tool's therapeutic, forensic, and research applications.

Reference to the DSM has been removed from the title to underscore that the SCID-D's assessment model does not depend on DSM or ICD nosology. The results of the SCID-D form a superset of information which can be mapped into the diagnostic criteria of any edition of the DSM or ICD.

The acronym "SCID-D" has been updated and now stands for the "Semi-Structured Clinical Interview for Dissociative Symptoms and Disorders." This is intended to emphasize that in addition to the dissociative disorders, the interview can be used in identifying dissociative symptoms present in other psychiatric conditions.

The design has been streamlined for ease of use in clinical settings.

An expanded "Psychiatric and Medical History" section includes questions related to somatic symptoms for scoring based on ICD-11 (International Classification of Diseases, 11th Revision), the global standard for diagnosis. An optional follow-up section has also been added for exploring the new ICD classification of Partial DID. This new follow-up section may be useful for researchers investigating whether Partial DID is meaningfully distinct from DID.

For those new to the SCID-D, further instructions and optional questions have been included that guide the interviewer in exploring varied manifestations of dissociative symptoms. For those clinicians using the SCID-D as an adjunct to therapy, optional therapeutically relevant questions have been added to the Follow-Up sections of the interview.

The 2023 edition of the Interviewer's Guide to the SCID-D, which is under development and forthcoming from American Psychiatric Association Publishing, includes expanded information about feedback and psychoeducation based on interview results; applications of the SCID-D method in therapy; dissociation in varied psychiatric conditions (e.g., posttraumatic stress, psychotic, mood, and other anxiety conditions); use in adolescent, adult, and forensic populations; and SCID-D psychometrics. Cross-cultural manifestations of dissociation and updated scientific references have also been included.

The content and sequence of the original questions remain unchanged from previous editions. Assessment of the five components of dissociation along a spectrum forms the basis for identifying symptom severity. Open-ended questions still encourage personalized follow-up. And emphasis remains on the importance of bringing attuned interviewing skills to systematic inquiry. Since it was unnecessary to make major revisions to the interview itself, the good-to-excellent psychometric properties of the previous editions persist (Piedfort-Marin, Tarquinio, Steinberg et al. 2021).

If you're a clinician, I hope you will familiarize yourself with the interview, as well as the Interviewer's Guide. You might begin by weaving some of the questions into your assessments and therapy. If you find that a client suffers from dissociative experiences, consider setting aside time to administer the full interview. For specialized training, consider attending a workshop or scheduling supervision with an expert in dissociation.

In my own work, I've marveled at the effect the interview can have on people whose symptoms were once labelled treatment-resistant or "psychotic." When they hear their experience reflected back to them for the first time without judgment or misattribution, I watch hope return as fear dissolves. Gradually, they grant me their trust, and we begin to explore the hidden, internal world that holds, somewhere inside it, the key to healing. Often, the interview is the first step on the road to recovery for those suffering from posttraumatic dissociation-it's the beginning of a journey that, when all is said and done, may be the most meaningful journey a person takes in their lifetime. I hope you find this enhanced version of the SCID-D useful both as a diagnostic interview and as a therapeutic method for helping your clients lead more authentic, fulfilling lives.

References

American Psychiatric Association: Diagnostic and Statistical Manual of Mental Disorders, 5th Edition. Arlington, VA, American Psychiatric Association, 2013

Bailey T., Boyer S., Brand B.: Dissociative disorders, in Diagnostic Interviewing. Edited by Segal D. New York, Springer, 2019, pp. 401-424

Bakim B., Baran E., Diyaddin M., et al.: Comparison of the patient groups with and without dissociative disorder comorbidity among the inpatients with bipolar disorder. Family Practice & Palliative Care 1(2):35-42, 2016

Boon S., Draijer N.: Diagnosing dissociative disorders in the Netherlands: a pilot study with the Structured Clinical Interview for DSM-III-R Dissociative Disorders. American Journal of Psychiatry 148:458-462, 1991

Boon S., Draijer N.: Multiple Personality Disorder in the Netherlands: A Study on Reliability and Validity of the Diagnosis. Lisse, the Netherlands, Swets & Zeitlinger Publishers, 1993

Bowman E.S.: Why conversion seizures should be classified as a dissociative disorder. Psychiatric Clinics of North America 29(1): 185-211, 2006

Brand B.L., Loewenstein R., Spiegel D.: Dispelling myths about dissociative identity disorder treatment: an empirically based approach. Psychiatry 77(2): 169-189, 2014

Brand B.L., Sar V., Stavropoulos P., et al.: Separating fact from fiction: an empirical examination of six myths about dissociative identity disorder. Harvard Review of Psychiatry 24( 4):257-270, 2016

Brand B.L., Classen C.C., McNary S.W., Zaveri P.: A review of dissociative disorders treatment studies. Journal of Nervous and Mental Disease 197(9):646-654, 2009

Brand B.L., McNary S. W., Myrick A.C., et al.: A longitudinal naturalistic study of patients with dissociative disorders treated by community clinicians. Psychological Trauma: Theory, Research, Practice, and Policy, 5(4):301-308, 2013

Bremner D., Steinberg M., Southwick S., et al.: Use of the Structured Clinical Interview for DSM-IV Dissociative Disorders for systematic assessment of dissociative symptoms in posttraumatic stress disorder. American Journal of Psychiatry 150(7): 1011-1014, 1993

Brown D., and Elliot D.: Attachment Disturbances in Adults: Treatment for Comprehensive Repair. New York, W.W. Norton, 2016

Carlson E., Dalenberg C., McDade-Montez E.: Dissociation in Posttraumatic Stress Disorder, Part I: definitions and review of research. Psychological Trauma: Theory, Research, Practice, and Policy 4(5):479-489, 2012

Carrion V., Steiner H.: Trauma and dissociation in delinquent adolescents. Journal of the American Academy of Child and Adolescent Psychiatry 39:353-359, 2000

Child and Adolescent Health Measurement lnitiative: National Survey of Children's Health: Survey Year 2017-2018

Chaiavi S., Vissia E., Giesen M., et al.: Abnormal hippocampal morphology in dissociative identity disorder and post-traumatic stress disorder correlates with childhood trauma and dissociative symptoms. Human Brain Mapping 36(5): 1692-1704, 2015

Chang A.J., Chang S.H., Shiah J.S., Huang C.W.: Preliminary study of the DES and SCID-D Chinese versions on college students of National Defense Medical Center. Paper presented at the the 22nd International Society for the Study of Dissociation International Conference, November 2005

Coons P.: The differential diagnosis of multiple personality. A comprehensive review. Psychiatric Clinics of North America 7(1):51-68, 1984

Coons P., Bowman E., Milstein V.: Multiple personality: a clinical investigation of 50 cases. Journal of Nervous and Mental Disease 176(9):519-527, 1988

Darvos-Bornoz J.: Rape-related psychotraumatic syndromes. European Journal of Obstetrics & Gynecology and Reproductive Biology 71(1):59-65, 1997

Darves-Bomoz J.M., Degiovanni A., Gaillard P.: Why is dissociative identity disorder infrequent in France. American Journal of Psychiatry 152(10):1530-153 I, 1995

Darves-Bomoz J.M., Lepine J.P., Choquet M., et al.: Predictive factors of chronic post-traumatic stress disorder in rape victims. European Psychiatry 13(6):281-287, 1998

Darvos-Bomoz J., Berger C., Degiovanni A., et al.: Similarities and differences between incestuous and nonincestuous rape in a French follow-up study, Journal of Traumatic Stress 12(4):613-623, 1999

Dimitrova L.J.,Dean S.L., Schlumpf Y.R. et al.: A neurostructural biomarker of dissociative amnesia: a hippocampal study in dissociative identity disorder. Psychological Medicine June 24; 1-9, 2021

Dorahy M., Van der Hart O.: DSM-5's Posttraumatic Stress Disorder with Dissociative Symptoms: challenges and future directions. Journal of Trauma & Dissociation 16:7-28, 2015

Fine C.: A cognitively based treatment model for DSM-TV dissociative identity disorder, in Handbook of Dissociation. Edited by Michelson L.K., Ray W.J. Boston, MA, Springer, 1996, pp. 401-441

Finn S., Martin H.: Therapeutic assessment: using psychological testing as brief therapy, in APA Handbook of Testing and Assessment in Psychology, Vol. 2: Testing and Assessment in Clinical and Counseling Psychology. Edited by Geisinger K.F., Bracken B.A., Carlson J.F., et al. Washington, DC, American Psychological Association, 2013, pp. 453-465

Finn S., Fischer C., Handler L. (eds.): Collaborative/Therapeutic Assessment: A Casebook and Guide. Hoboken, NJ, Wiley, 2012

Fisher J.: Healing the Fragmented Selves of Trauma Survivors: Overcoming Internal Self-Alienation. New York, Routledge, 2017

Foote B., Smolin Y., Neft D., et al.: Dissociative disorders and suicidality in psychiatric outpatients. Journal of Nervous and Mental Disease 196(1):29-36, 2008

Friedl M., Draijer N.: Dissociative disorders in Dutch psychiatric inpatients, American Journal of Psychiatry 157(6):1012-1013, 2000

Gast U., Rodewald F., Nickel V., et al.: Prevalence of dissociative disorders among psychiatric inpatients in a German university clinic. Journal of Nervous and Mental Disease 189:249-257, 2001

Gilbert P.: Compassion Focused Therapy: Distinctive Features. New York, Routledge, 2010

Gingrich H.: Dissociative symptoms in Filipino college students. Philippine Journal of Psychology 37(2):50-78, 2004

GoffD., Olin J., Jenike M., et al.: Dissociative symptoms in patients with obsessive-compulsive disorder. Journal of Nervous and Mental Disease 1.80(5):332-337, 1992

Haugen M., Castillo R.: Unrecognized dissociation in psychotic outpatients and implications of ethnicity. Journal of Nervous and Mental Disease 187(12):751-754, 1999

Herman J.: Trauma and Recovery. New York, Basic Books, 2015

Hill S., Wolff J., Bigony C., et al.: Dissociative subtype of posttraumatic stress disorder in women in partial and residential levels of psychiatric care. Journal of Trauma & Dissociation 21(3):305-318, 2019

Howell E.: Trauma and Dissociation Informed Psychotherapy: Relational Healing and the Therapeutic Connection. New York, W.W. Norton, 2020

International Society for the Study of Trauma and Dissociation: Guidelines for treating dissociative identity disorder in adults. Journal of Trauma & Dissociation 6(4):69-149, 2005 (see also: 3rd Edition, 2011)

Janet P.: The Major Symptoms of Hysteria: Fifteen Lectures Given in the Medical School of Harvard University. New York, Macmillan, 1907

Jepsen E., Langeland W., Sexton H., et al.: Inpatient treatment for early sexually abused adults: a naturalistic 12-month follow-up study. Psychological Trauma: Theory, Research, Practice, and Policy 6(2):142-151, 2014

Johnson J., Cohen P., Kasen S., Brook J.: Dissociative disorders among adults in the community, impaired functioning, and axis l and II comorbidity. Journal of Psychiatric Research 40(2): l 3 l-140, 2006

Karadag F., Sar V., Tamar-Gurol D., et al.: Dissociative disorders among inpatients with drug or alcohol dependency. Journal of Clinical Psychiatry 66(10):1247-1253, 2005

Kim I., Kim D., Jung H.: Dissociative identity disorders in Korea: two recent cases. Psychiatry Investigation 13(2):250-252, 2016

Kluft R.: The natural history of multiple personality disorder, in Childhood Antecedents of Multiple Personality. Edited by Kluft R.P. Washington, DC, American Psychiatric Press, 1985, pp. 197-238

Kluft R.: First-rank symptoms as a diagnostic clue to multiple personality disorder. American Journal of Psychiatry 144(3):293-298, 1987

Kluft R.: Basic principles in conducting the psychotherapy of multiple personality disorder, in Clinical Perspectives on Multiple Personality Disorder. Edited by Kluft R.P., Fine C.G. Washington, DC, American Psychiatric Press, 1993, pp. 19-50

Kluft R.: A clinician's understanding of dissociation: fragments of an acquaintance, in Dissociation and the Dissociative Disorders. Edited by O'Neil J., Dell P. New York, Routledge, 2015, pp. 599-624

Kluft R., Bloom S., Kinzie J.: Treating the traumatized patient and victims of violence. New Directions in Mental Health Services Summer (86)79-102, 2000

Knudsen, H., Draijer, N., Haselrud, J., Boe, T., et al.: Dissociative disorders in Norwegian psychiatric inpatients. Paper presented at the Spring meeting of the International Society for the Study of Dissociation, Amsterdam, The Netherlands, 1995

Kundakçi T., Sar V., Kiziltan E., et al.: Reliability and validity of the Turkish version of the Structured Clinical Interview for DSM-IV Dissociative Disorders (SCID-D): a preliminary study. Journal of Trauma & Dissociation 15(1):24--34, 2014

Loewenstein R.J.: Dissociation debates: everything you know is wrong. Dialogues in Clinical Neuroscience 20(3):229-242, 2018

Logue M.W., van Rooij S.J.H., Dennis E.L., et al.: Smaller hippocampal volume in posttraumatic stress disorder: a multisite ENIGMA-PGC study: subcortical volumetry results from posttraumatic stress disorder consortia. Biological Psychiatry 83(3):244--253, 2018

Lyssenko L., Schmahl C., Bockhacker L., et al.: Dissociation in psychiatric disorders: a meta-analysis of studies using the dissociative experiences scale. American Journal of Psychiatry 175(] ):3 7-46, 2018

Mobajerin B., Lynn S., Bakhtiyari M., et al.: Evaluating the unified protocol in the treatment of dissociative identify disorder. Cognitive and Behavioral Practice 27(3):270--289, 2020

Mueller C., Moergeli H., Assaloni H., et.al.: Dissociative disorders among chronic and severely impaired psychiatric outpatients. Psychopathology 40( 6):4 70-4 71, 2007

Mueller-Pfeiffer C., Rufibach K., Perron N., et al.: Global functioning and disability in dissociative disorders. Psychiatry Research 200(2-3):475-48 J, 2012

Mueller-Pfeiffer C., Rufibach K., Wyss D., et al.: Screening for dissociative disorders in psychiatric out-and day care-patients. Journal of Psychopathology and Behavioral Assessment 35(4):592-602, 2013

Mychailyszyn M., Brand B., Webermann A., et al.: Differentiating dissociative from non-dissociative disorders: a meta-analysis of the structured clinical interview for DSM dissociative disorders (SCID-D). Journal of Trauma & Dissociation 22(1):1-16, 2020

Nijenhuis E.: Somatoform dissociation: major symptoms of dissociative disorders. Journal of Trauma & Dissociation 1(4): 7-3 2, 2000

Perry B., Dobson C.: The neurosequential model of therapeutics, in Treating Complex Traumatic Stress Disorders in Children and Adolescents: Scientific Foundations and Therapeutic Models. Edited by Ford J., Courtois C. New York, Guilford Press, 2013, pp. 249-260

Piedfort-Marin 0., Tarquinio C., Steinberg M., et al.: Reliability and validity study of the French-language version of the SCID-D semi-structured clinical interview for diagnosing DSM-5 and ICD-11 dissociative disorders. Annales Medico-psychologiques 180(6):51-59, 2022

Prince M.: The Dissociation of a Personality. London, Longmans, Green, & Co., 1925

Putnam F., Guroff J., Silberman E.K., et al.: The clinical phenomenology of multiple personality disorder: review of 100 recent cases. Journal of Clinical Psychiatry 47(6):285-293, 1986

Reinders A.A.T.S., Willemsen A.T.M., Vos H.P.J., et al.: Fact or factitious? A psychobiological study of authentic and simulated dissociative identity states. PloS One 7(6), 2012

Roco V., Hart J., Kinbrell T., et al.: Cognitive function and dissociative disorder status among veteran subjects with chronic posttraumatic stress disorder: a preliminary study. Journal of Neuropsychiatry and Clinical Neurosciences 18(2):226--230, 2006

Rodewald F.: Diagnostics of dissociative disorders. Doctoral dissertation, Hannover Medical School, Hanover, Germany, 2005

Roydeva MI, Reinders AATS: Biomarkers of pathological dissociation: a systematic review. Neuroscience and Biobehavioral Reviews 123(1):120-202, 2020

Sar V.: Epidemiology of dissociative disorders: an overview. Epidemiology Research International 404538, 2011

Sar V., Onder C., Kilicaslan A., et al.: Dissociative identity disorder among adolescents: prevalence in a university psychiatric outpatient unit. Journal of Trauma & Dissociation 15(4):402-419, 2014

Sar V., Kundakçi T., Kiziltan E., et al.: The axis-I dissociative disorder comorbidity of borderline personality disorder among psychiatric outpatients. Journal of Trauma & Dissociation 4(1): 119-136, 2003

Sar V., Koyuncu A., Ozturk E., et al.: Dissociative disorders in the psychiatric emergency ward. General Hospital Psychiatry 29(1):45-50, 2007

Schwartz R.: Introduction to the Internal Family Systems. Oak Park, IL, Trailheads Publications, 2001 (2023 Edition)

Siegel D: The Developing Mind, How Relationships and the Brain Interact to Shape Who We Are. New York, Guilford Press, 2020

Sinason V (ed.): Attachment, Trauma, and Multiplicity. East Sussex, UK, Routledge, 2010 (2011 Edition)

Somer E., Altusa L., Ginzburg K.: Dissociative psychopathology among opioid use disorder patients: exploring the "chemical dissociation" hypothesis. Comprehensive Psychiatry 51 :419-425, 2010

Spiegel D., Cardena E.: Dissociative mechanisms in posttraumatic stress disorder, in Posttraumatic Stress Disorder: Etiology, Phenomenology, and Treatment. Edited by Wolf M., Mosnaim A. Washington, DC, American Psychiatric Press, 1990, pp. 23-34

Spiegel D., Rosenfeld A.A.: Spontaneous hypnotic age regression: case report. Journal of Clinical Psychiatry 45(12):522-524, 1984

Steele K., Van der Hart O., Nijenhuis E.: Phase-oriented treatment of structural dissociation in complex traumatization: overcoming trauma related phobias. Journal of Trauma & Dissociation 6(3):I l-53, 2005

Steinberg M.: Interviewer's Guide to the Structured Clinical Interview for DSM-IV Dissociative Disorders (SCID-D). Washington, DC, American Psychiatric Press, 1993a

Steinberg M.: Structured Clinical Interview for DSM-IV-R Dissociative Disorders (SCID-D). Washington, DC, American Psychiatric Press, 1993b

Steinberg M.: Handbook for the Assessment of Dissociation: A Clinical Guide. Washington, DC, American Psychiatric Press, 1995

Steinberg M.: Advances in the clinical assessment of dissociation: the SCID-D-R. Bulletin of the Menninger Clinic 64(2): 146-163, 2000

Steinberg M., Schnall M.: The Stranger in the Mirror: Dissociation—The Hidden Epidemic. New York, Harper Collins, 2010

Steinberg M., Steinberg A.: Systematic assessment of dissociative identity disorder in adolescents using the SCID-D: three case studies. Bulletin of the Menninger Clinic 59:221-231, 1995

Steinberg M., Hall P.: The SCID-D diagnostic interview and treatment planning in dissociative disorders. Bulletin of the Menninger Clinic 61: 108-120, 1997

Steinberg M., Cicchetti D., Buchanan J., et al.: Distinguishing between multiple personality disorder and schizophrenia using the structured clinical interview for DSM-IV dissociative disorders (SCID-D). Journal of Nervous and Mental Disease 182(9):495-502, 1994

Steinberg M., Rounsaville BJ., Cicchetti D.V.: The structured clinical interview for DSM-III-R dissociative disorders: preliminary report on a new diagnostic instrument. American Journal of Psychiatry 147(1):76-82, 1990

Steinberg M., Rounsaville B.J., Cicchetti D.V.: [Detection of dissociative disorders in psychiatric patients by a screening instrument and a structured diagnostic interview](https://europepmc.org/article/med/1853955. American Journal of Psychiatry 148(8):1050-1054, 1991

Steinberg M., Barry D., Sholomskas D., and Hall P.: SCL-90 symptom patterns: indicators of dissociative disorders. Bulletin of the Menninger Clinic 69(3):237-249, 2005

Swart S., Wildscbut M., Draijer N., et al.: Dissociative subtype of posttraumatic stress disorder or PTSD with comorbid dissociative disorders: comparative evaluation of clinical profiles. Psychological Trauma: Theory, Research, Practice and Policy 12(1):38-45, 2020

Tanner J., Wyss D., Perron N., et al.: Frequency and characteristics of suicide attempts in dissociative identity disorders: a 12-month follow-up study in psychiatric outpatients in Switzerland. European Journal of Trauma & Dissociation 1(4):235-239, 2017

Van der Hart O., Nijenhuis E., Steele K.: Dissociation: an insufficiently recognized major feature of complex posttraumatic stress disorder. Journal of Traumatic Stress 18(5):413-424, 2005

Van der Hart O., Nijenhuis E., Steele K.: The Haunted Self: Structural Dissociation and the Treatment of Chronic Traumatization. New York, W.W. Norton, 2006

Watkins H., Watkins J.: Ego States: Theory and Therapy. New York, W.W. Norton, 1997

Welburn K.R., Fraser G.A., Jordan S.A., et al.: Discriminating dissociative identity disorder from schizophrenia and feigned dissociation on psychological tests and structured interviews. Journal of Trauma & Dissociation 4(2): 109-130, 2003