Latest / System Speak: Complex Trauma and Dissociation / Guest: Mary-Anne Kate, PhD

Transcript

Guest: Mary-Anne Kate, PhD · System Speak: Complex Trauma and Dissociation

• 0:08
  Speaker 1: Over:
• 0:11
  Speaker 2: Welcome to the System Speak Podcast, a podcast about Dissociative Identity Disorder. If you are new to the podcast, we recommend starting at the beginning episodes and listen in order to hear our story and what we have learned through this endeavor. Current episodes may be more applicable to long time listeners and are likely to contain more advanced topics, emotional or other triggering content, and or reference earlier episodes that provide more context to what we are currently learning and experiencing. As always, please care for yourself during and after listening to the podcast. Thank you.
• 0:59
  Our guest today is Doctor. Mary Ann Cate, an award winning postdoctoral researcher specializing in interpersonal trauma, attachment, and post traumatic disorders. She is a scientific committee member of the International Society for the Study of Trauma and Dissociation, where she also teaches the introductory course on dissociation alongside Christine Forner. Maryann is the lead author of the chapter on dissociative and somatic disorders in Wiley's Abnormal Psychology textbook and has written articles on post traumatic disorders including dissociative disorders, complex PTSD, and borderline personality disorder. Doctor.
• 1:46
  Kate also has over a decade's experience as senior policy officer in Canberra, a program manager in Cairo, and a policy analyst in Brussels, improving quality of life outcomes, including mental health for vulnerable client groups such as migrants, refugees, and other minorities. Doctor. Kate lives on the Mid North Coast of New South Wales in Australia and currently teaches on the Master in Mental Health program at Southern Cross University and holds an adjunct research position at the University of New England. Please note that this episode has a trigger warning for references of different kinds of abuse. There is no disclosure, discussion, or detailed examples given, but different types of abuse are referenced in passing during discussion of categorizing abuse for research.
• 2:41
  As always, take care of yourself while you listen and after you listen. Thank you. Welcome, doctor Mary Anne Kate. Just just so that you know where we're coming from, doing the podcast is absolutely terrifying despite that I tell you it's going to be so easy. Because the podcast I have no no opportunity but to be out.
• 3:12
  I don't have a choice anymore. I sort of crossed the line and ISSTD has been as a whole has been very safe and kind to me and I'm grateful because I thought I would just get kicked out as one of the crazy people despite all the compassion they talk about. But they have been very kind to me.
• 3:35
  Speaker 1: I mean, I've been so pleased watching because from the Australian context, the first person I ever got in contact about my research was Cathy Kesselman, who has DID. And I'm sure you've interviewed Cathy. It was a meeting with Warwick Middleton and Kathy, just looking at the respect Kathy was afforded. And I find her such an inspiring, incredible woman. But I don't know, it just felt really important to share that with you because of when I read through what work you've done and I've heard people talk so highly of your podcast and I can only imagine how difficult it is for you to do as well.
• 4:14
  Speaker 2: Oh my goodness, I'm grateful to hear that actually because no one tells me and so I have no idea what they are thinking but I've not gotten a cease and desist letter so I just keep going.
• 4:28
  Speaker 1: Well you got an award it's the opposite so you know.
• 4:32
  Speaker 2: Yeah that's right I forgot about that. The awards we didn't even have to go get it. We worked so hard to try to prepare ourselves to be able to go up and we didn't even have to go because it all got cancelled.
• 4:47
  Speaker 1: Oh that's right. Yes. So yeah. At the very last minute.
• 4:52
  Speaker 2: Oh, okay. Yes. So Kesselman has been on the podcast. Warwick Mendelton has been on the podcast, and I met him in San Francisco. So you are amongst safe, good people, and I am grateful for that.
• 5:04
  I'm I'm glad to know that. If you want to go ahead and start introducing yourself, just clinically, your work, your research, if you're seeing patients or you're not, or where you're working.
• 5:16
  Speaker 1: Hi, I'm Mary Anne Cates, and it's wonderful to be able to share my research. I work with a lot of colleagues who are clinicians, but I am not. I come from a background in social policy, like looking at the way that governments work and how do we make programs that really help people. And I've always had this interest in trauma. Working in the migration and refugee space has been my background for ten, fifteen years, and looking at what are their experiences and what can we do to help people overcome the traumatic experiences and also learn from different ways of being and thinking.
• 6:06
  And so there's a lot in identity about that as well. So that's another theme that came into play about, well, how do we manage different kinds of identity, whether they be national identities, issues about culture or religion. And when it comes to dissociation, we can see that there's something similar emerging, this pattern of trauma and identity. So it was quite a big change for me to go down a clinical pathway. But I was watching what was happening in Australia and internationally about people that were having these experiences of horrific abuse and all sorts of kind of child abuse and struggling to be seen and heard and believed.
• 7:00
  And I thought that it was really important, you know, where was the advocacy around this? And it really resonated with a lot of the work that I'd done before. So, you know, I set off on my doctoral research journey for many years and then became really knowledgeable on dissociation and dissociative disorders. And that was through meeting people with dissociation and speaking with them and interviewing them and talking really closely with people that work as trauma therapists. And in the end, I was involved in writing a textbook with Doctor.
• 7:48
  Warwick Middleton on dissociative and somatic disorders, which really changed the information that was out there, as well as in my own research, really showing what is it that predicts dissociation and dissociative disorders. What is it that really causes this? And, you know, is there any truth in this idea that there's a role for fantasy? So I'm sure we will talk about many of those things. I completed my PhD round about two years ago now, and at the moment, I teach people in mental health who are doing their master's program at Southern Cross University, as well as doing research as well on dissociative disorders and trauma related disorders, which I continue to do.
• 8:38
  Speaker 2: We actually have several areas that have been a little parallel that I want to connect with you on. One is that Doctor. Middleton has been on the podcast and so the listeners have heard him and have heard him talk about dissociation and DID. It was an episode where I think he was outside while we were recording and so you could hear birds at times and it was a bit funny because it's actually turned out to be one of my favorite bits for the podcast because there was no way to edit them out and now because of the pandemic we have moved to the country and so sometimes I can sit outside on my front porch and I pretend I'm just hanging out with Doctor. Middleton and I met him in San Francisco for the ISSTD conference which was then cancelled and moved virtually and so I heard you speak at the recent ISSTD conference which is why I wanted to talk to you on the podcast but I did not know that you had also worked with refugees because we have done that as well.
• 9:48
  I have done that as well. And the thing about working with refugees is that I feel like they move from one trauma, which is really a lot of traumas but I mean one traumatic situation into a whole other kind of trauma. And so I'm fascinated that this is a piece that sort of overlaps with us that I didn't realize about. Absolutely. When you are talking with people about dissociation, how do you define dissociation?
• 10:19
  What's your understanding of dissociation?
• 10:21
  Speaker 1: I like to keep it very broad and relatable. So I do see it as this response that is really similar to depression and to anxiety in that it's people's reaction to really difficult circumstances. And the way that people may react to that is to different levels, depending on their own inner resources and the trauma, is having to disconnect the experience to make it manageable, to make the person be able to cope. And I even think ways simple ways of being that we don't even think of being dissociative or important, like where there's grieving. So, somebody has lost their spouse that they have loved throughout their life, and they have to organize a funeral, and that's all these things they have to do.
• 11:15
  And they can't possibly begin to feel the emotional content of this intense loss and grief. So they just concentrate on all of the details, and they cut out their emotional state until that's over, and then they're able to to grieve. So I think that it's a natural thing that everyone does, and it just depends on how systematic this disconnection from the self becomes, and the level of threat, and how ongoing it is. Because for many people, the threat becomes so big that it is a constant way of being, and then shapes identity in a really profound way. But I do see it as being a disconnection to make the experience manageable.
• 12:03
  And sometimes that is conscious, but often it is not. I think it can become an automated process over time. But also, you know, when we look at things like polyvagal theory, then it also has a place in cases of extreme fear where the person is unable to fight or flee for various reasons. And the shutdown response happens with no conscious awareness, and dissociation can be really in that space. So the way the disconnection can happen can be different, but I see that as being this common theme in understanding dissociation.
• 12:46
  And when we look at it in that way, it makes sense to everyday people. And they realize, oh, you know, I'm actually doing that. And the truth is people are. Even if we look at the dissociative experiences in the dissociative experiences scale, the general people in the general population, everyday people on average think they're dissociating 10% of their day. That's a lot.
• 13:13
  So that's this general level of this sort of disconnection that people are having. And obviously, it can become more pathological. But I like the idea of people using it in their everyday speak. And I'm starting to see more of this where people are going, oh, I was I felt really dissociated when that happened. And they may not be people that would have in the past even had that terminology.
• 13:41
  But I think once people understand it, it becomes like saying, you know, Oh, when this happened, I became really depressed for a matter of weeks, you know, and they might talk about, you know, this anxiety that they were feeling. So I think that it's a really important concept to be able to bring in to this relatable way that every p you know, people feel a lot of the time.
• 14:06
  Speaker 2: This is why your your presentation at the ISSTD conference this weekend got my attention because Simone Renier's research that came out in the spring about confirming with the MRI studies dissociation happening and DID as a diagnosis and the significance of relational trauma I feel like really has redefined completely what trauma is. And you're saying the same thing from a different approach that dissociation is way more common than we realize and really is a broader experience than what we're calling it. So that it's definitely more common and experienced more frequently by more people than what people have realized before.
• 15:02
  Speaker 1: Absolutely. And I think on brain scans, you know, we're not going to see that obviously in people that are dissociating in a more common form. And I do think that it's those pathways that become ingrained over time that, you know, we're really seeing. And, you know, there can sort of be those epigenetic vulnerabilities already in place from, you know, stress in utero. We know with DID how profound and long the trauma is, it's pretty much most often this lifelong experience where the brain is being shaped over a long period of time.
• 15:43
  And I think that this has been so valuable, this research, in showing the reality of dissociative identity disorder. But on the same hand, I often find it difficult that people focus on dissociative identity disorder. And then often there's this missing of the bridges between. So people see it as this curiosity. And a lot of people don't want to believe in the reality of it despite the evidence.
• 16:14
  And in the same conference, you know, we were lucky enough to have, you know, Judy Herman there, and she really talks to us about this concept where, you know, we don't wanna hear, see, and speak evil. You know, we we don't we would prefer to think the world is a safe and lovely place. And when we have to look at the reality of what it is that causes dissociative identity disorder, people would in effect prefer not to believe. And, you know, even when we have this incredible evidence, such as the imaging studies that Simone Reindeers has done.
• 16:50
  Speaker 2: Can you go ahead and explain for listeners who were not able to hear you speak, could you go ahead and explain a little bit about what the fantasy model or the trauma model, what those mean and how they're different?
• 17:04
  Speaker 1: Absolutely. So in the nineties and this this actually goes back a long way, so I might actually take us back even further to Freudian times. So in Freud's time, he was seeing these women who were dissociative. They had hysteria, which it was seen as in those days. And what he was seeing was these histories of incest.
• 17:27
  And he thought that this was, you know, this incredibly cruel experience that had changed these women and really compromised their mental health. And when he came out about this and talked about it openly, he was cast out of society and not being able to be part of things. People did not want to hear it, and particularly because there was some very influential Viennese families that were involved in this, you know, that could afford to be, you know, taking their, you know, their adult daughters to psychiatrists. You know, this was this was these really wealthy people. And what he was saying, in effect, is when we're seeing this, this is the cause.
• 18:12
  So when he was cast out, it was a really difficult time for him. And then suddenly, he comes up with a, oh, this was made up. This is a fantasy that, you know, young girls have, you know, the Oedipus complex, you know, this fantasy about the sexual relationship with the father. And, you know, he comes up with this psychosexual theory of development. And then he's allowed back in society and things go on and it's okay.
• 18:41
  And, you know, we've seen this throughout history. In the 90s, this became a really big thing, the idea of fantasy, that these stories of where there was this incredible level of these intense histories of trauma that they weren't real, and somebody had imagined this to be true. And that was much more palatable than realizing the reality of child abuse, which people don't want to see. Particularly where it was happening in families or that was seen as upstanding members of the community. And often with dissociative identity disorder, we see the same thing.
• 19:23
  You know, they will describe, people describe their families as being, you know, behind closed doors, one thing, but this very different way that it was perceived by the public. And, you know, I've always struggled with this theory, even before I knew much about it because it made no sense to me. Because, you know, we're designed as human beings to to connect, to stay within our social groups, to strengthen our social bonds. And it's like, well, why would anyone develop a fantasy that they were abused? Because that cuts against their support and their way of being connected, their chance of survival.
• 20:04
  So it always sounded quite strange to me. And people like Elizabeth Loftus would say, oh, well, these people just have lots of psychological problems, and it's a way for them to make sense of what they're experiencing. And I remember reading that and thinking, well, that doesn't sound like anyone with dissociation because so many people that have, like, structural levels of dissociation, this intense dissociation, they don't want that to be true. They would you know, they often go through these huge doubts, often for years at a time, and it can really be lifelong. Did it happen?
• 20:42
  Did I make it up? Could it be true? They want to connect. Often, there's this, you know, this intense wish to be loved and cared for by their family. So it didn't really ring true to me, the fantasy model of dissociation.
• 20:59
  But what it says is these people who are a bit vulnerable, and it used to not be about trauma, but the goalposts kept changing with what we call the fantasy model. And then suddenly, people could have had a real history of trauma, and they're very fantasy prone. And we know that that's true because being fantasy prone is a way to escape harsh realities. It's a really good coping mechanism. So it's not as if that's not true, but it doesn't mean that a person has then also constructed these awful fantasies.
• 21:33
  And you think if you're gonna escape from something awful in your fantasy prone mind, you're not gonna think about something awful. It's going to be being somewhere else. And, you know, this is what I've seen in the women with dissociative identity disorder that I've interviewed is that, you know, it is that way of being somewhere else. So they will be outside in nature on the ceiling. They're disconnecting from something awful that's going on around them, and that's this great use of fantasy.
• 22:07
  Or of also not looking at the harsh realities of the world. So it is escaping into all sorts of fantasy as merely recreation. So there could be elements of that. But in the fantasy model, it's very strong, often in lots of textbooks where they're saying dissociative identity disorder isn't actually real, and most dissociative disorders are not actually real. The person is enacting them from seeing information, like watching The United States Of Tara, for example, or a civil or bringing faces of Eve, and that somehow these people And it can be a bit from therapist suggestion, and it used to be that used to be a big part of what they would say, that therapists would say, Oh, you know, I think you have dissociative disorder.
• 22:54
  And these people would go, Oh, really? Oh, I do. Okay. I believe you. You know, it was just really simple process.
• 23:03
  It's But it's not like that at all. But, again, I think it's this really palatable option, this idea that people just make it up, and it becomes this victim blaming thing as well. Like, it's like, oh, we don't have to worry about that. These people are just confused, and what happened to them didn't really happen. There's no cause for alarm.
• 23:27
  And what I also find interesting about people that support the fantasy model is a lot of them work as expert witnesses in child abuse cases. And often in cases where these people have been convicted of other crimes of sexual abuse against children or sexual assaults against other people, like in the case of Bill Cosby, and you would have people like Elizabeth Loftus stepping in. And as expert witnesses, we can probably gauge or imagine that they're paid quite a lot of money to do this. So that's part of what they do as well, is this discrediting the testimony of abuse survivors. And the people in the fantasy model are involved in that as well.
• 24:13
  So, you know, that I find that interesting about, well, is there this secondary gain from it as well as this just not wanting to believe. What I found difficult is how do you disprove the fantasy model if it's true or not true? Because all the factors that are in the trauma model, where the trauma model is like people experience trauma and then there is this change in the way that they are psychologically. It's a coping strategy. And there we have a dissociative disorder.
• 24:50
  So it's the trauma and attachment, like insecure attachment in infancy, where the caregiver isn't attending to the child's needs and the child becomes dysregulated or frightened and anxious and they don't know what to do. They can't go towards their caregiver because they're afraid of their caregiver, but they want to go towards their caregiver. So there's these you know, there's a lot of longitudinal studies that show these really early experiences, even in infancy, that are going to predict dissociation in adulthood. So we we know that to be the case. But the trauma model has these similarities where we go, well, yeah, people can be fantasy prone, and that makes a bit of sense.
• 25:41
  And there's also information that shows that people that are dissociative are a tiny bit suggestible and aren't as good at monitoring reality. And that's really marshaled in the fantasy model theorists in their theory to say, well, these people, it's clear because they're suggestible that this would happen and that they can't monitor reality. But the way that I look at it is that if you have a dissociative disorder, how do you monitor reality in the same way as somebody that doesn't? And if you're not present and your autobiographical memory is problematic and your short term memory is problematic, how are you not suggestible if it seems plausible? And this is what we often talk about in the field, is the suggestion plausible?
• 26:30
  And there's been all sorts of studies done around this where they talk about You've probably heard about the Lost in the Mall study, where adults were told that as they were children, they were lost in the mall and serious events happened. There's a lot of criticisms about the way the study was done. But even the underlying premise about, you know, isn't it plausible that you would have been lost in a mall? And I think anyone that's ever had children will know that there's a moment, like, usually many moments that you will be shopping, and you will be in a shopping center, and you turn around and you can't see your child, and this is complete panic, or the child's become really distressed because they can't see you and they panic. So I think that it's such a common experience anyway.
• 27:13
  So even if a person doesn't recall it happening or they've had similar things happening in other context, it's not it's not a difficult thing to imagine may have happened to you. And I think it's very different than somebody, you know, being told that, you know, when you were young, you were sexually abused by an uncle who just happened to be the favorite uncle. And, you know, somebody having to, you know, really struggle to process that kind of information, it's going to be much harder to readily accept if that was false than being told something that's fairly innocuous, really, about being lost. And when I've looked at these studies, there's another one, and it looks at negative things happening like being attacked, I think, by an animal and a few different this was being researched as really pushing that this memory is true. They're saying this memory is true because your parents told us it was true.
• 28:11
  You should remember it. You need to go and work on it for a week trying to remember this. You need to write about what it might have been like. And these people did develop a bit of a partial memory for these events under this I mean, it was completely false what was being told. I mean, the ethics of that are interesting in itself.
• 28:31
  And some of them did go on to develop a memory of something that actually didn't happen. But what was interesting in that study proving that people can have false memories of something is that they actually found that about 10% of the real memories of the actual trauma that happened, they had forgotten. So in proving that, on one hand, that yes, if you really put a lot of effort, you can convince somebody of something that plausibly could have happened to them, and they're being told that this actually did by a great reference source, I. E, their own parents. Yeah.
• 29:10
  And then on the other hand, there was, you know, I think from memory around about ten percent of people didn't forget the real trauma that had actually happened. So, yeah, in my own research, I was like, how can I prove this? This is so entangled. And I ended up just looking at, you know, how prevalent is dissociation and what makes sense. And, you know, what I found is that in general population, around ten percent of people will meet the diagnostic criteria for dissociative disorder, which is massive.
• 29:39
  And most people will probably also meet the criteria for depression or anxiety or PTSD or borderline personality disorder. A great many other diagnoses is probably, I think, in the general population, seventy five percent of people would have a dissociative disorder. It's something that's comorbid. And what we say comorbid, so like two or disorders together. And what I found is there's not enough fantasy prone people to be dissociative.
• 30:08
  Like, basically three times as many people as there are fantasy prone, we'd have to find three times as many that are fantasy prone. And every single fantasy prone person there was would have to have managed to have enough information about a dissociative disorder to enact one, and would have to of all the things they could do, they could go on and be a creative artist, which, you know, a lot obviously are, or, you know, come up with any number of delusions potentially. But, you know, it's like every single person would have to have gone down this very specific and very odd path. So, you know, that didn't make sense. And also, that would have to be enacting something they're familiar with.
• 30:53
  But dissociative identity disorder is the most commonly known, but it's actually the the one that we find the least. Like, it's the the least common dissociative disorder. So that wouldn't make sense either because, you know, if we were imagining from popular culture, surely, then it would be the most popular disorder that people would think that they would have. And then I also thought about things like, well, how should it vary across countries? Because, you know, it said that, oh, well, it's a North American phenomenon, and you hear this a lot.
• 31:27
  It's a North American phenomenon, but it's not. Like, if it's trauma model, well, trauma's everywhere. We should just go in with our tools and dig, dig, dig, dig with our tools wherever in the world, and we will find it. And that is the truth of it. Dissociation is global.
• 31:45
  And my other theory was that we should find more of it where there's more trauma. So if we go into communities with more trauma, and we know that, you know, for example, in black communities, there's more exposure to trauma, so there is more dissociation. And that's just sort of regionally in The States or within communities in The States. So I also thought, well, if we go to countries that are more unsafe and there's more exposure to interpersonal trauma, surely there should be you know, we might be able to see, you know, something happening there. And that's what I did and, you know, pulled together all of these studies.
• 32:22
  It was, 92 studies that looked at dissociative experiences university students, and that's what came out of it. You know, the countries like Switzerland that are considered to be very safe had really low levels. The States was actually really midranging, and it was like Peru that was the highest. So and that tallied with the level of safety in those countries. But that cuts against the idea of, well, they should if it was a fantasy model, it was true, and people were just imagining it from watching, you know, there's too many sociocultural portrayals, and we should see more in North well, we should definitely see the most in North America, but that just didn't hold out.
• 33:01
  And there's also a fantasy model theorist, Joel Paris, oh, you know, doesn't exist anymore. Like, it's basically dead. DID was a thing of the nineteen nineties, and, you know, it's tailed off, you won't find it anymore. So I also looked at over the last thirty years, have rates of dissociation increased or decreased? And they'd stayed relatively stable, a slight nonsignificant increase, actually.
• 33:27
  Yeah. So, you know, that didn't show itself to be true either. So, whichever way I looked at it, it was like, this isn't an explanation for all of the dissociation that is out there. But when we looked at trauma, that may it made sense. So the amount of dissociation, when we look at just in the general population, is actually the same as people that have experienced what we say, like the ACE studies, Adverse Childhood Experiences.
• 33:58
  It's around about the same as people that have experienced four or more types of adverse experiences. And we know from people with dissociative disorders that it tends to be like that. Like, it's usually not just one kind of abuse. So, that made sense. It made sense when we look at the prevalence of trauma.
• 34:16
  Not everyone that has trauma will dissociate. Some people will. And the ten percent figure really made sense in light of that.
• 34:25
  Speaker 2: I feel like this is huge. This was huge information that is confirming what we thought, but you brought out the research to show it.
• 34:35
  Speaker 1: Yes, and it was really having to think about a different way because the fantasy model theorists, it's like they've created a playing field and the goalpost kept shifting. And I was like, well, how do we play? You know, how do we compete? And I think we were so bound by the rules of what the fantasy model theorists had said. So I was really trying to just think around that where, you know, in a way that it could be proved.
• 34:58
  And in saying that, I can't say that there's not not ever going to be a case that is, you know, a fantasy model generator, but we can definitely say that the majority of, the vast majority of cases wouldn't be that way. It doesn't make any sense. But Colin Ross is probably I don't know if you've heard Colin Ross talk about this, but he's definitely aware of cases where there has been iatrogenic therapist created DID, what looks like DID. But it's been not just a simple suggestion. This has been where people have been misdiagnosed.
• 35:31
  The therapist has been a lot of malpractice, and the person's been on an inpatient ward for literally years, had communication cut from their family. It was like really, nearly mind control kind of situations where that's been developed. So it's not to say that it would be, you know, it's not a possibility for that to happen, but you know, is an unlikely scenario on the whole.
• 35:55
  Speaker 2: It feels significant that the data that you found matched these other areas, like the ACEs, for example, and that it was consistent across the board from even the previous studies.
• 36:08
  Speaker 1: Yeah, yeah, absolutely. And I mean, when I started looking at this, I remember being so shocked about how dissociative people were. And it sort of happened when I did some research in a university sample in Australia, and they were like thirteen percent of the time being dissociative. And I was sure that I'd got it wrong. Like, this is where I really started looking at how dissociative are people and, you know, what should I be expecting as normal?
• 36:35
  Because I thought that I had just done something completely wrong. I thought maybe it's just 1.3 or yeah. And so but then the more I looked, and it's reinforced in all the studies. And what was interesting is the fantasy model theorists, they actually, in their own studies, had the highest levels of dissociation. Their levels of average dissociation were nearly in students, like, one standard deviation upwards, so not very far.
• 37:02
  This is in the their normal range was, like, pathological levels of dissociation. So on one hand, they were saying, you know, dissociation isn't real. It doesn't exist. It's not valid. And yet they were finding these really high rates of dissociation.
• 37:16
  And then also in the same breath saying dissociative disorders aren't found in college populations. And what I looked at is that in their research design, they weren't even their research design was never intended to show that. So they weren't even interviewing people on the basis of whether they were dissociative. Sometimes it was that they might be fantasy prone, that they'd had this adult sexual trauma as an adult. But they weren't screening on the basis of dissociation, and they weren't even interviewing the majority of people.
• 37:49
  There was a small amount of interviews, and then they would say, Oh, we don't find it very often in university populations. It's really rare. But the way they were looking was just so chaotic. In one study, they even removed all the people that had been sexually abused. And we know that sexual abuse is the biggest risk factor.
• 38:08
  So they went and found the people that were likely to have it, removed them all from the study. So, it was really interesting, and yet this sort of same statement kept appearing in these studies saying, you know, this research shows that dissociative disorders aren't found in college students. And it was really baffling.
• 38:28
  Speaker 2: What do you think, how would you explain what this means for clinicians and what it means for survivors?
• 38:34
  Speaker 1: I think it's about validating experience. And we can forget when we're in little bubbles, like in the world of the ISSTD, the International Society for the Study of Trauma and Dissociation, because, you know, it's like everyone we feel is on the same page, and a lot of people that, you know, there's this great support. But often out there still, you know, there'll be psychiatrists that will not diagnose or believe in DID, and they've got this real mindset from the nineties that it's not real. So it's being able to challenge that. And this is one part of the information that people can challenge with.
• 39:18
  Because it's really appealing to people's sensibilities. And obviously, if somebody's a psychiatrist, they've got pretty good critical thinking skills and highly intelligent. We would expect to get to that level. So I think that these neuroimaging studies are fantastic as well. And it's like reminding people, no, this is real.
• 39:40
  Like, you haven't made it up. For people that are survivors, it's that important information and that reinforcement. No, it's okay. It's it's normal to feel that way. And I think the fantasy model can make people doubt their own experience.
• 39:55
  So it's not even just being up against this idea that, oh, people are gonna think that it's not true. I think it reinforces survivors' feelings of it not being true, that, you know, I made it up, I'm bad, and these narratives are often easier to accept than accepting, you know, being harmed at the hands of those who were supposed to love, care, and protect them. So knowing that that's a pretty normal feeling, that it would be normal for them to be a bit fantasy prone, that doesn't mean that they've made it up.
• 40:29
  Speaker 2: I'm really, really grateful to you and your hard work and for sharing that with us.
• 40:34
  Speaker 1: Thank you. Thank you.
• 40:35
  Speaker 2: Are there any other pieces of it or anything? I know it's so much to pack in a little time, but is there anything else that you really wanted to share or emphasize while we still have you on the phone?
• 40:47
  Speaker 1: Well, I think that the other important thing that I managed to do through my research is look at how do we predict dissociation. And, you know, this idea that it's just trauma can often miss a lot. So, you know, I really delved into, you know, what is it exactly that is going to predict dissociation. And before, because the dissociative experience scale is so commonly used, and it actually was designed to find dissociative identity disorder. So it's not very good at finding the mid range of dissociation.
• 41:22
  It's like this high level and more normal. And the fantasy model use it a lot. And things like sexual abuse aren't related to it, which is weird. Like, you're like and these are the things that I started to question in my research, like, why that should be true? Why is that not true?
• 41:39
  And I ended up finding out it was because of the way that dissociation was being measured. So I decided to look at studies that were using clinical interviews and the multidimensional inventory of dissociation, and the trauma symptom checklist had this dissociation subscale. And the research that was the most predictive had actually used that. It's only five items, five questions on dissociation. But that really found emotional abuse and sexual abuse together, this combination, sort of predicted about thirty four percent variance and dissociation.
• 42:10
  So that was the most compelling study that I'd found. And so in my research, and this is just when I was just looking at university students, and I was looking at this group of 300, just over 300 university students. And, you know, I was able to show that it was this that it was these it was sexual abuse or life these life threatening potentially life threatening experiences, which can include abandonment and, serious neglect, like really extreme physical violence that's really frightening where people are really worried, the levels of threats about death. But these things occurring against this backdrop where there was this negative family life and there wasn't this support, there wasn't a protection. And we imagine that if there was protection, people wouldn't have chronic trauma during childhood.
• 43:04
  So that's one thing that was really missing is this idea of, you know, who stepped in? Who was going to stop this? And that wasn't happening. So in looking at all those, I was able to predict half of the variants in dissociation in adults, and that was far more than had ever been done. And what was I found really interesting in it, and a bit of a trigger warning for this, one part of it was oxygen deprivation was a huge risk factor.
• 43:34
  So, people that had experienced some kind of smothering or choking and had been sexually abused were nearly at a hundredfold risk of having clinical levels of dissociation, which is absolutely massive when we think about smoking and lung cancer being a fortyfold risk. So, this was this incredible risk of having a dissociative disorder. And the other thing that really struck me was that for males, I couldn't find physical abuse being influential, although for them, sexual abuse also was, and this emotional abuse was more important. But there were some really interesting things that came out about it too, just about, well, what were the situations people grew up in that you know, what was the parenting like and these things about not being worthwhile. So I I made these questions because we can't think of everything that happens to people, but how about the way they feel?
• 44:27
  So, you know, I designed all these questions, and it might be things like, you know, I grew up to believe that I mattered and I was worthwhile. And these were incredibly protective against any dissociation. So if people had these really validating experiences, they were really unlikely to be dissociative if they believed that they, you know, were valued, if they believed they were worth comforting. I mean, this was huge. You know, this is, 20 fold risk factors just for asking simple questions.
• 44:56
  And, you know, I've really thought about this recently about how this can help with clinicians who might be worried about, you know, oh, is there a trauma history I'm not hearing about? Or is someone dissociated their trauma history and not wanting to ask? And the idea, well, there's gentle ways of exploring this, you know, just asking, you know, did you grow up to feel that you were loved and you were worthwhile and that you mattered? Not to say it's not a triggering question in its own right, but it's not as confronting. Just knowing that right there you've got a twenty fold risk of a dissociative disorder if someone's answer incorrectly or asking them, If you're really hurt and upset and there's somebody that you think you trust, can you seek comfort from them?
• 45:38
  And the person goes, Oh, not really. Or talks about not feeling that they have a secure attachment, that they're really worried about their attachment to other people. So these are really big risk factors that can be explored so we can get a sense of how likely the risk is. And I think there's also utility in using it in children as well, where people often don't want to ask questions because of mandatory reporting. So they don't ask the questions about trauma.
• 46:10
  But the idea of maybe there's other questions that we can ask that get to the nature of what trauma does and the relationship that exists in this environment of chronic complex trauma. How does it make people feel? And looking at that as a risk factor for working out what children, for example, you know, if it's a teacher in a classroom. So it would have lots of different contexts where I think that this could be used. And another thing that I did in my research, which has just been validated, is using a short version of this instrument that measures dissociation called the multidimensional inventory of dissociation.
• 46:51
  And it's two eighteen questions, so it's quite long, plus diagnostics. So at the end, you find out which diagnosis it would be, and it's this incredible it's an incredible tool. But a lot of clinicians don't use it because of its length. And I was also worried about research because the dissociative experiences scale wasn't showing that sexual abuse was important. It wasn't picking up dissociative amnesia.
• 47:15
  Like, ninety four percent of cases of dissociative amnesia were being missed. And so, you know, I was really keen to look at, well, can we find another way of screening for dissociation? And so that's just been validated, this short version of the multidimensional inventory of dissociation, the 60 question version, which gives a bit of a diagnostic impression, but it's not sorry. It gives an impression of what dissociative disorder might be there, as well as looking at the somatoform symptoms and PTSD. So it gives a nice overview of what the person might be experiencing without it being as lengthy.
• 47:53
  So that was another useful part of my research. But I'm still working with it all and listening to the stories of the women that I've interviewed and thinking about, you know, what next. And so it's an it's an ongoing it's it's an ongoing objective of mine to look at what have I learned and how can I use this to to help people?
• 48:18
  Speaker 2: It's so important what you have done. We are so so grateful for you and for your hard work on this truly.
• 48:25
  Speaker 1: Thank you.
• 48:25
  Speaker 2: I mean it. I mean it.
• 48:27
  Speaker 1: I think that it's just really important that people walk away understanding that the for people with dissociation that, you know, it wasn't it wasn't their their choice, but it was a great protective strategy that enabled them to really be in an environment that they wouldn't have been in otherwise. That dissociation makes a lot of sense. And I think that the more that we can validate dissociation and dissociative disorders, then that really helps to support people. And that's what you're doing as well. So thank you so much, Emma, for all your work.
• 49:01
  Speaker 2: Thank you for talking to us.
• 49:03
  Speaker 1: You're so welcome. No, that was good. Might see you in Seattle. Who knows?
• 49:09
  Speaker 2: Oh, that would be lovely.
• 49:10
  Speaker 1: I would be The Seattle conference. Yes. Take care. Bye. Bye.
• 49:25
  Speaker 2: Thank you for listening. Your support of the podcast, the workbooks, and the community means so much to us as we try to create something together that's never been done before, not like this. Connection brings healing, and you can join us on the community at www.systemsspeak.com. We'll see you there.