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Brain Sciences
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Traumatic Stress and Dissociative Disorder
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Traumatic Stress and Dissociative Disorder

A special issue of Brain Sciences (ISSN 2076-3425). This special issue belongs to the section "Neuropsychiatry".

Deadline for manuscript submissions: closed (19 September 2025) | Viewed by 12823

Special Issue Editor

Dr. Federica Visco-Comandini

E-Mail Website
Guest Editor
Scuola di Psicoterapia Cognitiva, Rome, Italy
Interests: trauma; dissociation; transcultural settings; mood; relational trauma; interpersonal violence

Special Issue Information

Dear Colleagues,

[*] Background and history of this topic:

There is a very strong link between dissociative disorders and trauma exposure, particularly early childhood trauma, disruptions in attachment and caregiving, and domestic violence. The psychopathological consequences of trauma exposure include mood, anxiety, disruptive behaviors, and substance abuse disorders; among these, dissociation represents a specific coping mechanism of traumatized individuals, especially those exposed to complex traumas.

Dissociation can be defined as disconnections between thoughts, feelings, behaviors, sensations, and other mental processes normally connected. In conditions where traumatic experiences are overwhelming, dissociation can represent one of the main coping mechanisms that allows people to distance themselves from a trauma that may otherwise be unbearable.

When dissociation continues, real danger no longer exists; however, it can prolong or even prevent recovery from abuse and neglect.

[*] Aim and scope of the Special Issue:

 (i) Describe the cognitive and behavioral functioning of those exposed to traumatic experiences and manifest dissociative states; (ii) describe prevention strategies and/or early interventions; and iii) evaluate the effectiveness of conventional or innovative psychotherapeutic treatments in the general population, as well in a transcultural setting.

[*] Cutting-edge research: The goal of this Special Issue is to foster innovation and the more widespread use of evidence-based approaches and to share insights obtained from field experience, inter-cultural views, and academic knowledge in order to enhance knowledge of dissociative states as consequences of different type of trauma exposure.

[*] What kind of papers we are soliciting: Original research articles, clinical report cases, and reviews

Dr. Federica Visco-Comandini
Guest Editor

Manuscript Submission Information

Manuscripts should be submitted online at www.mdpi.com by registering and logging in to this website. Once you are registered, click here to go to the submission form. Manuscripts can be submitted until the deadline. All submissions that pass pre-check are peer-reviewed. Accepted papers will be published continuously in the journal (as soon as accepted) and will be listed together on the special issue website. Research articles, review articles as well as short communications are invited. For planned papers, a title and short abstract (about 100 words) can be sent to the Editorial Office for announcement on this website.

Submitted manuscripts should not have been published previously, nor be under consideration for publication elsewhere (except conference proceedings papers). All manuscripts are thoroughly refereed through a single-blind peer-review process. A guide for authors and other relevant information for submission of manuscripts is available on the Instructions for Authors page. Brain Sciences is an international peer-reviewed open access monthly journal published by MDPI.

Please visit the Instructions for Authors page before submitting a manuscript. The Article Processing Charge (APC) for publication in this open access journal is 2200 CHF (Swiss Francs). Submitted papers should be well formatted and use good English. Authors may use MDPI's English editing service prior to publication or during author revisions.

Keywords

  • PTSD
  • dissociation
  • C-PTSD
  • trauma exposure
  • interpersonal violence
  • abuse
  • relational trauma
  • childhood abuse

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Published Papers (4 papers)

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Research

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19 pages, 1162 KB  
Article
Beyond the Scars: An Analysis of Adverse Childhood Experiences and the Interconnections Between Emotion Dysregulation, Dissociation, and Trauma in Patients with Borderline Personality Disorder
by Luciana Ciringione, Enrico Perinelli, Francesco Mancini and Elena Prunetti
Brain Sci. 2025, 15(8), 889; https://doi.org/10.3390/brainsci15080889 - 20 Aug 2025
Viewed by 1913
Abstract
Background/Objectives: Borderline Personality Disorder (BPD) frequently overlaps with trauma-related conditions, particularly PTSD and Complex PTSD (cPTSD). Adverse Childhood Experiences (ACEs)—especially emotional and sexual abuse—are considered key factors in the development of emotion dysregulation and dissociation. This study investigates the impact of different [...] Read more.
Background/Objectives: Borderline Personality Disorder (BPD) frequently overlaps with trauma-related conditions, particularly PTSD and Complex PTSD (cPTSD). Adverse Childhood Experiences (ACEs)—especially emotional and sexual abuse—are considered key factors in the development of emotion dysregulation and dissociation. This study investigates the impact of different ACE dimensions on borderline symptomatology, emotion dysregulation, and dissociative symptoms. Methods: Eighty-three BPD patients were assessed using standardized self-report questionnaires: CTQ-SF (ACEs), DERS (emotion dysregulation), DES (dissociation), BSL-23 (borderline symptoms), and PDS-3 (post-traumatic symptoms). Analyses included bivariate correlations, Structural Equation Modeling (SEM), and Exploratory Graph Analysis (EGA). Results: Emotional abuse significantly predicted borderline symptoms, while sexual abuse predicted dissociation. Emotion dysregulation was strongly associated with both borderline and dissociative symptoms, emerging as a central node in the symptom network. EGA confirmed the clustering of dissociative symptoms with sexual abuse and the centrality of emotion dysregulation across domains. Conclusions: Findings support the role of specific ACEs in shaping the clinical expression of BPD. Emotion dysregulation acts as a key transdiagnostic factor linking trauma history to borderline and dissociative features. These results underscore the importance of trauma-informed assessments and interventions, such as DBT and DBT-PTSD, tailored to individual ACE profiles. Full article
(This article belongs to the Special Issue Traumatic Stress and Dissociative Disorder)
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Review

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34 pages, 1456 KB  
Review
The High-Risk Model of Threat Perception Modulates Learning of Placebo and Nocebo Effects and Functional Somatic Disorders
by Ian Wickramasekera
Brain Sci. 2025, 15(9), 955; https://doi.org/10.3390/brainsci15090955 - 2 Sep 2025
Viewed by 897
Abstract
Threat activation or deactivation in the brain–body is associated with learned nocebo or placebo somatic effects induced by fake invasive medical–surgical procedures. Some functional somatic disorders (FSDs) originate as acute nocebo somatic effects and can become 30–50% of chronic somatic presentations to primary [...] Read more.
Threat activation or deactivation in the brain–body is associated with learned nocebo or placebo somatic effects induced by fake invasive medical–surgical procedures. Some functional somatic disorders (FSDs) originate as acute nocebo somatic effects and can become 30–50% of chronic somatic presentations to primary care physicians. Patients with FSD overutilize medical–surgical services, despite the lack of identified pathophysiology, and are at risk for morbidity from unintentional iatrogenic injury. The Conditioned Response Model (CRM) of learning postulates three innate mechanisms, modulated by trait hypnotizability, which drive placebo and nocebo somatic effects and FSD. The High Risk Model of Threat Perception (HRMTP) postulates 10 psychosocial risk factors that modulate threat perception, driving placebo and nocebo somatic effectsandbiologically embedded FSD. Psychosocial factors and the trait of high and low hypnotizability modulate threat and are postulated to reduce heart rate variability(HRV), inducing autonomic nervous system(ANS)dysregulation. Reduced HRV was found in a large (N = 6,891) sample of patients with FSD. A total of 50% of patients with FSD with chronic pain (n = 224) without identified pathophysiology had a Paradoxical Increase in hand Temperature (PTI) during experimental threat induction. The HRMTP predicts that PTI associated with ANS dysregulation is associated with the risk factor Adverse Childhood Experiences (ACEs). This ACE prediction was independently confirmed. Learning predicts that threat activation by unconscious neutral stimuli (CS) can amplify nocebo and FSD and can negate placebo effects in clinician–patient relationships. Identifying psychosocial risk factors that modulate threat perception enables the diagnosis of FSD by inclusion and not simply by excluding pathophysiology. Full article
(This article belongs to the Special Issue Traumatic Stress and Dissociative Disorder)
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Other

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21 pages, 1387 KB  
Case Report
The Body as a Vessel for Trauma: The Clinical Case Study of Aisha
by Federica Visco-Comandini, Alberto Barbieri, Francesco Mancini and Alessandra Ciolfi
Brain Sci. 2025, 15(1), 94; https://doi.org/10.3390/brainsci15010094 - 20 Jan 2025
Viewed by 5193
Abstract
This case study examined the process of integration of cognitive behavioral therapy (CBT) and sensorimotor psychotherapy (SP) in three-phase trauma treatment with a 32-year-old female Bengali refugee with Complex Post Traumatic Disorder (C-PTSD). The treatment was provided in a Western country. The client’s [...] Read more.
This case study examined the process of integration of cognitive behavioral therapy (CBT) and sensorimotor psychotherapy (SP) in three-phase trauma treatment with a 32-year-old female Bengali refugee with Complex Post Traumatic Disorder (C-PTSD). The treatment was provided in a Western country. The client’s improvement was assessed by using self-report assessments of post-traumatic, dissociative, and depressive symptoms. Psychodiagnostics’ scores gathered after 2 years of treatment showed significant improvements in post-traumatic, dissociative, and depressive symptoms. Although firm conclusions cannot be drawn due to the limitations of this study, results suggest that integrating CBT and SP in a phase-trauma approach may be an effective treatment for C-PTSD in a transcultural setting. However, replicating and standardizing such preliminary results on larger samples is necessary. Background/Objectives: SP is an innovative psychotherapeutic intervention aimed at treating trauma through a bottom-up approach, however, little research exists regarding the efficacy of this psychotherapy. This case study aims to investigate the efficacy of the combination of CBT and SP in treating a C-PTSD patient in a transcultural setting. Methods: Three questionnaires were administered to investigate post-traumatic, depressive, and dissociative symptoms. Results: Clinical and psychodiagnostic outcomes highlight significant psychological improvements in the patient. Conclusions: Although any firm conclusion cannot be drawn because of various intrinsic limitations (i.e., single case study) that straiten our ability to extend these results, this case study suggests that the integration of CBT and SP may be an effective treatment for C-PTSD in a transcultural setting. Full article
(This article belongs to the Special Issue Traumatic Stress and Dissociative Disorder)
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17 pages, 1091 KB  
Case Report
“I Am Longing and Afraid to Depend on You”: A Case Report on Breakdowns of Therapeutic Alliance and Interpersonal Cycles in Complex Trauma
by Carolina Papa, Erica Pugliese, Claudia Perdighe, Ramona Fimiani and Francesco Mancini
Brain Sci. 2024, 14(12), 1207; https://doi.org/10.3390/brainsci14121207 - 28 Nov 2024
Cited by 1 | Viewed by 3966
Abstract
Background: Patients with Complex Trauma (CT) may have an impaired ability to trust others and build intimate relationships due to non-integrated representations of self and others. This sometimes leads to an oscillation between needing and fearing intimacy in their adult relationships. This dynamic [...] Read more.
Background: Patients with Complex Trauma (CT) may have an impaired ability to trust others and build intimate relationships due to non-integrated representations of self and others. This sometimes leads to an oscillation between needing and fearing intimacy in their adult relationships. This dynamic can occur in the therapeutic relationship, undermining the effectiveness of therapy and affecting the mental health of both the patient and the therapist. To date, no study has analyzed interpersonal patient–therapist dynamics in cases of CT. The present case aims to fill this gap by exploring relational cycles between the therapist and the patient during the therapeutic process in terms of goals and self–other beliefs. Methods: The methodology consisted of a shared and integrated reconstruction by the patient and therapist, both with clinical expertise in psychology, of the impasse in their therapeutic relationship. The reading was done through the lens of the cognitive model of Pathological Affective Dependence, a theory of traumatic relationships, by describing the primary interpersonal cycles occurring in the therapeutic relationship (altruistic, deontological, and vulnerable). Results: The condition of CT leads to several alliance breakdowns and specific interpersonal cycles, leading to new healing meanings for the patient and the relationship itself. Limitations: The study’s main limitation is that it consists of a qualitative analysis of the therapeutic relationship without data that can quantify the clinically observed changes. Conclusions: This case report demonstrates how CT, PAD and the fear of intimacy can be risk factors for the therapeutic alliance and how the therapeutic relationship constitutes a fundamental tool for intervention effectiveness in patients who experience unmet primary needs. Full article
(This article belongs to the Special Issue Traumatic Stress and Dissociative Disorder)
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