Dissociative Disorders in India: Cultural Influence on Psychopathology and Treatment

The authors review findings from the psychology of religion showing that believers' perceived relationships with God meet the definitional criteria for attachment relationships. They also review evidence for associations between aspects of religion and individual differences in interpersonal attachment security and insecurity. They focus on two developmental pathways to religion. The first is a "compensation" pathway involving distress regulation in the context of insecure attachment and past experiences of insensitive caregiving. Research suggests that religion as compensation might set in motion an "earned security" process for individuals who are insecure with respect to attachment. The second is a "correspondence" pathway based on secure attachment and past experiences with sensitive caregivers who were religious. The authors also discuss conceptual limitations of a narrow religion-as-attachment model and propose a more inclusive framework that accommodates concepts such as mindfulness and "nonattachment" from nontheistic religions such as Buddhism and New Age spirituality. Show more

We present recommendations for revision of the diagnostic criteria for the Dissociative Disorders (DDs) for DSM-5. The periodic revision of the DSM provides an opportunity to revisit the assumptions underlying specific diagnoses and the empirical support, or lack of it, for the defining diagnostic criteria. This paper reviews clinical, phenomenological, epidemiological, cultural, and neurobiological data related to the DDs in order to generate an up-to-date, evidence-based set of DD diagnoses and diagnostic criteria for DSM-5. First, we review the definitions of dissociation and the differences between the definitions of dissociation and conceptualization of DDs in the DSM-IV-TR and the ICD-10, respectively. Also, we review more general conceptual issues in defining dissociation and dissociative disorders. Based on this review, we propose a revised definition of dissociation for DSM-5 and discuss the implications of this definition for understanding dissociative symptoms and disorders. We make the following recommendations for DSM-5: 1. Depersonalization Disorder (DPD) should derealization symptoms as well. 2. Dissociative Fugue should become a subtype of Dissociative Amnesia (DA). 3. The diagnostic criteria for DID should be changed to emphasize the disruptive nature of the dissociation and amnesia for everyday as well as traumatic events. The experience of possession should be included in the definition of identity disruption. 4. Should Dissociative Trance Disorder should be included in the Unspecified Dissociative Disorder (UDD) category. There is a growing body of evidence linking the dissociative disorders to a trauma history, and to specific neural mechanisms. © 2011 Wiley-Liss, Inc. Show more

Approaches to trance and possession in anthropology have tended to use outmoded models drawn from psychodynamic theory or treated such dissociative phenomena as purely discursive processes of attributing action and experience to agencies other than the self. Within psychology and psychiatry, understanding of dissociative disorders has been hindered by polemical "either/or" arguments: either dissociative disorders are real, spontaneous alterations in brain states that reflect basic neurobiological phenomena, or they are imaginary, socially constructed role performances dictated by interpersonal expectations, power dynamics and cultural scripts. In this paper, we outline an approach to dissociative phenomena, including trance, possession and spiritual and healing practices, that integrates the neuropsychological notions of underlying mechanism with sociocultural processes of the narrative construction and social presentation of the self. This integrative model, grounded in a cultural neuroscience, can advance ethnographic studies of dissociation and inform clinical approaches to dissociation through careful consideration of the impact of social context. Show more