Taking all these discussions into consideration, it is reasonable to use the expression “traumatic stress” instead of “trauma” to describe causative events for the development of dissociative disorder. The “traumatic stress” not only includes overt sexual and physical abuse, but also any circumstances which can elicit emotional distress such as fear, terror, and anxiety. These circumstances might not be recognized as trauma in its general sense as there might not be any overt physical, sexual or verbal aggression involved, but they are nonetheless strongly associated with the generation of dissociative pathology.
It was almost 10 years ago that I came up with the idea that some type of traumatic stress, less overt than sexual and physical trauma needs to be taken into consideration as one of the major causes for dissociative disorders. While still practicing in the US, I had a chance to learn about some of Japanese DID cases and had an impression that they are quite different from their US counterparts in terms of their social background. As I stated already, I chose to use an expression “relational stress” with an idea that pathological dissociation can be generated out or a close and stressful relationship with parental figures. But I needed my own clinical experiences with Japanese patients to further develop and concretize the notion of traumatic stress.
By the way, I would like to give you a heads-up on the terms “interpersonal stress” and “interpersonal trauma” that are used frequently these days. They can be easily confused with the notion of relational stress as they sound similar to each other. However, “interpersonal” simply connotes that stress or trauma is caused by other(s). Before these terms came into use, expressions such as “childhood sexual abuse” (CSA), childhood physical abuse (CPA), were frequently used to mean the same thing. Relational stress, on the other hand, is much more subtle and covert, including many emotional interactions and communications which are stressful to the children involved.
American Psychiatric Association (1980) Diagnostic and Statistical Manual. 3rd edition, A.P.A. (高橋三郎・花田耕一・藤縄昭訳 (1982) DSM-III精神障害の分類と診断の手引き. 医学書院)
Candel I, Merckelbach H (2004) Peritraumatic dissociation as a predictor of post-traumatic stress disorder: a critical review. Comprehensive Psychiatry, 45;44 - 50.
Creamer M, O'Donnell ML, Pattison P (2004) The relationship between acute stress disorder and posttraumatic stress disorder in severely injured trauma survivors. Behav Res Ther., 42;315-28.
Finkelhor, D. (1990) Sexual Abuse In the National Survey Of Adult Men And Women. Child Abuse and Neglect, 14, 19-28.
Gleaves DH. (1996) The sociocognitive model of dissociative identity disorder: a reexamination of the evidence.Psychol Bull., 120(1):42-59.
Griffin MG, Resick PA, Mechanic MB (1997) Objective assessment of peritraumatic dissociation: psychophysiological indicators. Am J Psychiatry, 154(8);1081-1088.
日本精神衛生会 (2002) 図説・日本の精神保健運動の歩み.
Okano K. (1997) The Notion of Dissociogenic Stress. Dissociation. 10: 130-134.
奥山眞紀子 (2004) 性的虐待へのケアと治療.そだちの科学. 2, 55-61.
Ross , C. (1997) Dissociative Identity Disorder, John and Wiley, New York.
Ursano RT, Fullerton CS, Benedek DM (2007) Peritraumatic Dissociation. Time perception and Cerebellar Regulation of Psychological, Interpersonal, and Biological Processes. Traumatic Dissociation: Neurobiology and Treatment. In Eric Vermetten E, Dorahy MJ, Spiegel (Ed.) D, M.D. Arlington, Va., American Psychiatric Publishing, 2007.
内村祐之 (1947) 精神医学者の滴想. 同盟出版社.
World Health Organization (1992) ICD-10 Classification of Mental and behavioral disorders: clinical Descriptions and Diagnostic Guidelines. WHO, Geneva. 融道男・中根允文・小見山実 (監訳) (1993) : ICD-10精神および行動の障害―臨床記述と診断ガイドライン. 医学書院)
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