The paper examined how dissociation is experienced and manifested in the drawings and narratives of female survivors of childhood sexual abuse (CSA) diagnosed with dissociative identity disorder. Fifteen Israeli women filled out a self-report questionnaire consisting of demographics, traumatic events, and dissociation severity. Then, they were asked to draw a dissociation experience and provide a narrative. The results indicated that experiencing CSA was highly correlated with indicators such as the level of fragmentation, the figurative style, as well as with the narrative. Two main themes emerged: a constant movement between internal and external worlds, and distorted perceptions of time and space.
AadilM.ShoaibM. (2017). Diagnostic challenges leading to under diagnosis of dissociative disorders. Neuropsychiatry Disorders Treatment, 13, 407–410. https://doi.org/10.2147/NDT.S131439
2.
AllenB.TusseyC. (2012). Can projective drawings detect if a child experienced sexual or physical abuse? A systematic review of the controlled research. Trauma, Violence, & Abuse, 13(2), 97–111. https://doi.org/10.1177/1524838012440339
3.
American Psychiatric Association (APA). (2013). Diagnostic and statistical manual of mental disorders: DSM-5 (5th ed.).
4.
BernsteinD. P.SteinJ. A.NewcombM. D.WalkerE.PoggeD.AhluvaliaT.StokesJ.HandelsmanL.MedranoM.DesmondD.ZuleW. (2003). Development and validation of a brief screening version of the childhood trauma questionnaire. Child Abuse & Neglect, 27(2), 169–190. https://doi.org/10.1016/s0145-2134(02)00541-0
5.
BernsteinE.PutnamF. W.RossC. A.ToremM.CoonsP.DillD.LoewensteinR. J.BraunB. G. (1993). Validity of the dissociative experiences scale in screening for multiple personality disorder: A multicenter study. American Journal of Psychiatry, 150, 1030–1036. https://doi.org/10.1176/ajp.150.7.1030
6.
BernsteinE. M.PutnamF. W. (1986). Development, reliability, and validity of a dissociation scale. Journal of Nervous Mental Disorders, 174(12), 727–735. https://doi.org/10.1097/00005053-198612000-00004
7.
BriggsE. C.Amaya-JacksonL.PutnamK. T.PutnamF. W. (2021). All adverse childhood experiences are not equal: The contribution of synergy to adverse childhood experience scores. American Psychologist Journal, 76(2), 243–252. https://doi.org/10.1037/amp0000768
8.
CarlsonE. B.PutnamF. W. (1993). An update on the dissociative experiences scale. Dissociation: Progress in the Dissociative Disorders, 6(1), 16–27.
9.
CernisE.FreemanD.EhlersA. (2020). Describing the indescribable: A qualitative study of dissociative experiences in psychosis. PLoS one, 15(2), Article e0229091. https://doi.org/10.1371/journal.pone.0229091
10.
CohenB. M.CoxC. T. (1995). Telling without talking: Art as a window into the world of multiple personalities. W.W. Norton.
11.
DalenbergC. J.BrandB. L.GleavesD. H.DorahyM. J.LoewensteinR. J.CardeñaE.FrewenP. A.CarlsonE. B.SpiegelD. (2012). Evaluation of the evidence for the trauma and fantasy models of dissociation. Psychological Bulletin, 138(3), 550–588. https://doi.org/10.1037/a0027447
12.
DellP. F. (2010). The phenomena of pathological dissociation. Dissociation and the dissociative disorders: DSM-V and beyond, 225, 491–493. https://doi.org/10.4324/9780203893920
13.
GobinR. L.FreydJ. J. (2014). The impact of betrayal trauma on the tendency to trust. Psychological Trauma: Theory, Research, Practice, and Policy, 6(5), 505–511. https://doi.org/10.1037/a0032452
14.
GoldnerL.FridL. (2022). Fragmentation of the self: Characteristics of sexual assault and implications in self-drawing. The Arts in Psychotherapy, 77, Article 101877. https://doi.org/10.1016/j.aip.2021.101877
15.
GoldnerL.Lev WieselR.BinsonB. (2021). Perceptions of child abuse as manifested in drawings and narratives by children and adolescents. Frontiers in Psychology Health Psychology,11. https://doi.org/10.3389/fpsyg.2020.562972
16.
Grassi-OliveiraR.Cogo-MoreiraH.SalumG. A.BrietzkeE.ViolaT. W.ManfroG. G.ArtecheA. X. (2014). Childhood trauma questionnaire (CTQ) in Brazilian samples of different age groups: Findings from confirmatory factor analysis. PLoS one, 9(1), Article e87118. https://doi.org/10.1371/journal.pone.0087118
17.
HaganM. J.HuletteA. C.LiebermanA. F. (2015). Symptoms of dissociation in a high–risk sample of young children exposed to interpersonal trauma: Prevalence, correlates, and contributors. Journal of Traumatic Stress, 28(3), 258–261. https://doi.org/10.1002/jts.22003
18.
HirakataP. (2009). Narratives of dissociation: Insights into the treatment of dissociation in individuals who were sexually abused as children. Journal of Trauma Dissociation, 10(3), 297–314. https://doi.org/10.1080/15299730902956804
19.
HouserR. A. (2019). Counseling and educational research: Evaluation and application. Sage Publications.
20.
KateM. A.JamiesonG.MiddletonW. (2021). Childhood sexual, emotional, and physical abuse as predictors of dissociation in adulthood. Journal of Child Sexual Abuse, 20, 1–24. https://doi.org/10.1080/10538712.2021.1955789
21.
KellettS.GreenhalghR.BeailN.RidgwayN. (2010). Compulsive hoarding: An interpretative phenomenological analysis. Behavioral and Cognitive Psychotherapy, 38(2), 141–155. https://doi.org/10.1017/S1352465809990622
22.
KøhlertF. B. (2015). Working it through: Trauma and autobiography in Phoebe Gloeckner’s a child’s life and the diary of a teenage girl. South Central Review, 32(3), 124–142. https://doi.org/10.1353/scr.2015.0035
23.
Lev-WieselR. (2005). Dissociative identity disorder as reflected in drawings of sexually abused survivors. The Arts in Psychotherapy, 32(5), 372–381. https://doi.org/10.1016/j.aip.2005.02.003
24.
Lev-WieselR. (2015). Childhood sexual abuse: From conceptualization to treatment. Journal of Trauma and Treatment, 4(259). https://doi.org/10.4172/2167-1222.1000259
25.
Lev-WieselR.HazanM.DanielM.GermanV.FingerZ.WeingerS.BinsonB. (2020). Children drawing violence: To what extent does it reflect actual experience. The Arts in Psychotherapy, 71, 101717. https://doi.org/10.1016/j.aip.2020.101717
26.
Lev-WieselR.LirazR. (2007). Drawings vs. narratives: Drawing as a tool to encourage verbalization in children whose fathers are drug abusers. Clinical Child Psychology and Psychiatry, 12(1), 65–75. https://doi.org/10.1177/1359104507071056
27.
Lev-WieselR.ShveroT. (2003). An exploratory study of self-figure drawings of individuals diagnosed with schizophrenia. Arts in Psychotherapy, 30(1), 13–16. https://doi.org/10.1016/S0197-4556(02)00232-0
28.
Lev-WieselR.ZoharG. (2014). The role of dissociation in self-injurious behavior among female adolescents who were sexually abused. Journal of Child Sexual Abuse, 23(7), 824–839. https://doi.org/10.1080/10538712.2014.950399
LyssenkoL.SchmahlC.BockhackerL.VonderlinR.BohusM.KleindienstN. (2018). Dissociation in psychiatric disorders: A meta-analysis of studies using the dissociative experiences scale. American Journal of Psychiatry, 175(1), 37–46. https://doi.org/10.1176/appi.ajp.2017.17010025
31.
MaesH. H.NealeM. C.KendlerK. S.HewittJ. K.SilbergJ. L.FoleyD. L.MeyerJ. M.RutterM.SimonoffE.PicklesA.EavesL. J. (1998). Assortative mating for major psychiatric diagnoses in two population-based samples. Psychological Medicine, 28(6), 1389–1401. https://doi.org/10.1017/s0033291798007326
32.
MaieseM. (2016). Embodied selves and divided minds. Oxford University Press.
33.
MauritzM. W.GoossensP. J.DraijerN.Van AchterbergT. (2013). Prevalence of interpersonal trauma exposure and trauma-related disorders in severe mental illness. European Journal of Psychotraumatology, 4(1), Article 19985. https://doi.org/10.3402/ejpt.v4i0.19985
34.
MichalM.KoechelA.CanterinoM.AdlerJ.ReinerI.VosselG.GamerM. (2013). Depersonalization disorder: Disconnection of cognitive evaluation from autonomic responses to emotional stimuli. PLoS One, 8(9), Article e74331. https://doi.org/10.1371/journal.pone.0074331
35.
OgdenT. (1986). The matrix of the mind: Object relations and the psychoanalytic dialogue. Jason Aronson.
36.
PeleikisD. E.MykletunA.DahlA. A. (2004). The relative influence of childhood sexual abuse and other family background risk factors on adult adversities in female outpatients treated for anxiety disorders and depression. Child Abuse & Neglect, 28(1), 61–76. https://doi.org/10.1016/j.chiabu.2003.08.003
37.
Pérez-FuentesG.OlfsonM.VillegasL.MorcilloC.WangS.BlancoC. (2013). Prevalence and correlates of child sexual abuse: A national study. Comprehensive Psychiatry, 54(1), 16–27. https://doi.org/10.1016/j.comppsych.2012.05.010
38.
PrinceM. (2011). Virtual identities from virtual environments. In PrinceM. (Ed.), Handbook of research on digital media and advertising: User-generated content consumption (pp. 335–344). IGI Global. https://doi.org/10.4018/978-1-60566-792-8
39.
RosenkranzS. E.MullerR. T.HendersonJ. L. (2012). Psychological maltreatment in relation to a substance use problem severity among youth. Child Abuse & Neglect, 36(5), 438–448. https://doi.org/10.1016/j.chiabu.2012.01.005
40.
SaltzmanA.BirolE.BouisH. E.BoyE.De MouraF. F.IslamY.PfeifferW. H. (2013). Biofortification: Progress toward a more nourishing future. Global Food Security, 2(1), 9–17. https://doi.org/10.1016/j.gfs.2012.12.003
41.
SarV. (2014). The many faces of dissociation: Opportunities for innovative research in psychiatry. Clinical Psychopharmacology and Neuroscience, 12(3), 171–179. https://doi.org/10.9758/cpn.2014.12.3.171
42.
ShapiroF. (2017). Eye movement desensitization and reprocessing (EMDR) therapy: Basic principles, protocols, and procedures. Guilford Publications.
43.
SiegelD. J. (2020). The developing mind: How relationships and the brain interact to shape who we are. Guilford Press.
44.
SilbergJ. L. (1998). Dissociative symptomatology in children and adolescents as displayed on psychological testing. Journal of Personality Assessment, 71(3), 421–439. https://doi.org/10.1207/s15327752jpa7103_10
Soffer-DudekN. (2014). Dissociation and dissociative mechanisms in panic disorder, obsessive-compulsive disorder, and depression: A review and heuristic framework. Psychology of Consciousness: Theory, Research, and Practice, 1(3), 243–270. https://doi.org/10.1037/cns0000023
47.
StolovyT.Lev-WieselR.EisikovitsZ. (2015). Dissociation and the experience of channeling: Narratives of Israeli women who practice channeling. International Journal of Clinical and Experimental Hypnosis, 63(3), 346–364. https://doi.org/10.1080/00207144.2015.1031555
TrickettP. K.NollJ. G.PutnamF. W. (2011). The impact of sexual abuse on female development: Lessons from a multigenerational, longitudinal research study. Development and Psychopathology, 23(2), 453–476. https://doi.org/10.1017/S0954579411000174
50.
VachonD. D.KruegerR. F.RogoschF. A.CicchettiD. (2015). Assessment of the harmful psychiatric and behavioral effects of different forms of child maltreatment. JAMA Psychiatry, 72(11), 1135–1142. https://doi.org/10.1001/jamapsychiatry.2015.1792
51.
WalshB. W. (2012). Treating self-injury: A practical guide. Guilford Press.
52.
WatersF. S. (2016). Healing the fractured child: Diagnosis and treatment of youth with dissociation. Springer Publishing Company.
53.
WeitenW.DunnD. S.HammerE. Y. (2014). Psychology applied to modern life: Adjustment in the 21st century. Nelson Education.
54.
WhitcombS.MerrellK. W. (2013). Behavioral, social, and emotional assessment of children and adolescents. Routledge.
