Guérin-Marion Camille, Sezlik Sage, Bureau Jean-François
School of Psychology, University of Ottawa, Ottawa, Ontario, Canada.
Eur J Psychotraumatol. 2020 Oct 14;11(1):1802908. doi: 10.1080/20008198.2020.1802908.
Numerous years of theory and research have informed our understanding of the caregiving experiences that confer vulnerability for dissociation. This work has resulted in widespread agreement on the role of childhood maltreatment as an aetiological factor. With clear integration of this perspective, the current paper draws attention to the spectrum of vulnerability that can exist over and above the trauma of maltreatment within early caregiving experiences. An integrative review of the developmental literature on dissociation is presented. We first review and integrate existing developmental theories of dissociation into a more unified perspective, highlighting a combination of defensive and intersubjective pathways towards dissociative outcomes. Next, we present empirical research demonstrating which specific caregiving experiences are associated with dissociation. Lastly, we review recent neurodevelopmental research demonstrating that (non-extreme) caregiving stressors during infancy impact the developing limbic structures in the brain. We conclude by offering directions for future research. Findings make the case for approaching assessments of the caregiver-child relationship with discernment of factors beyond the presence/absence of maltreatment when conceptualizing risk pathways toward dissociation.
多年来的理论和研究让我们对那些会使人易患分离性障碍的照料经历有了认识。这项工作使人们就童年期虐待作为一个病因因素的作用达成了广泛共识。在明确整合这一观点的基础上，本文提请注意在早期照料经历中，除了虐待创伤之外可能存在的一系列易感性。本文对关于分离性障碍的发展文献进行了综合综述。我们首先回顾并将现有的分离性障碍发展理论整合为一个更统一的观点，强调通向分离性结果的防御性和主体间性途径的结合。接下来，我们展示实证研究，证明哪些特定的照料经历与分离性障碍有关。最后，我们回顾最近的神经发育研究，该研究表明婴儿期（非极端的）照料压力源会影响大脑中正在发育的边缘结构。我们通过为未来研究提供方向来得出结论。研究结果表明，在概念化通向分离性障碍的风险途径时，在评估照料者与儿童的关系时，要辨别出虐待存在与否之外的其他因素。
