Complex Trauma and Dissociation: Charting a Course Forward for the Journal and the Field

I am deeply grateful for the opportunity to serve as Editor for the Journal of Trauma & Dissociation (JTD). Although I know that change is the nature of life, I actually never imagined JTD without Jennifer Freyd as its Editor, let alone the daunting prospect of following in her footsteps – and those of JTD’s eminent founding Editors, James Chu and Elizabeth Bowman. Over the past quarter century, with their leadership, JTD has established a record of excellence as a beacon of light for scholars, clinicians, policy makers, and advocates are dedicated to understanding the complexity of psychological trauma and dissociation and providing care for affected individuals, families, communities, and organizations. Like many other devoted readers of JTD, my education on the history, science, and social relevance of the intersection of trauma and dissociation began with Drs. Bowman and Chu’s prescient and inspiring editorial in JTD’s inaugural issue (Chu & Bowman, 2000). Over the next decades, JTD has continued to be the go-to source for knowledge in this inherently complex and controversial domain. In the spirit of Dr Freyd’s sage summation and benediction after almost two decades of service in her final editorial, and her wish that JTD should “live long and prosper” (Freyd, 2023), it is my goal to preserve and extend her and her predecessors’ invaluable legacy – a legacy shared by of all of us who contribute to JTD.

I am extremely fortunate to be joined in this endeavor by a team of outstanding Associate Editors, Editorial Board members, and production staff, as well as the remarkable group of past, current, and future JTD authors. Individually and collectively we represent a wide range of personal and professional backgrounds, and we each contribute expertise to JTD’s unique confluence of science, clinical practice, theory, advocacy, and policy related to complex psychological trauma and dissociation. Collectively, we represent a diversity of backgrounds, lived experiences, histories, cultures, and identities, global locales, fields of study and practice, and stages of career development – and this wide range of perspectives is a critical contributor to JTD’s excellence that I am committed to maintain and expand.

So, where do we go from here? I have some practical ideas for JTD that are extensions of past work, but not radical departures. To begin at the beginning, empiricism is at the heart of JTD’s work – the process of grounding our hypotheses, theories, evaluations, and conclusions in replicable and rigorous observation. JTD has developed a unique portfolio of empirical studies on the phenomenology, conceptualization, and psychometric assessment of complex psychological trauma and post-traumatic dissociation, and the psychotherapeutic treatment of dissociative and other trauma-related disorders. Inevitably, however, given the complexity of psychological trauma and dissociation, there remain many more questions than answers – which, although daunting, is fortunate, because there is much more for JTD to explore.

Of particular importance is the foundational question of how to define both complex psychological trauma (Ford, 2013, 2017, 2023a; Ford & Delker, 2018) and pathological dissociation (Carlson et al., 2012; Dell, 2011; Nijenhuis & van der Hart, 2011; Van der Hart & Dorahy, 2023). Complex trauma involves not only the shock and terror, helplessness, and horror that are the hallmark of all psychological traumas, but also a fundamental fragmentation of the survivor’s experience, which may take the form of extreme disorientation, detachment, and psychogenic amnesia due to the sense of disbelief and loss engendered by fundamental betrayal of core protective relationships and/or the social contract (Courtois, 2004; Freyd, 1994; Herman, 1992; van der Kolk et al., 1996). This trauma-related fragmentation of experience and memory appears to involve a very basic shift in the body that has been described as moving from a learning brain to a survival brain (Ford, 2020), and there is growing evidence that this is driven by altered functional connectivity within and between brain loci that correspond to persistence of a resultant alarm state (Nicholson et al., 2020; Terpou et al., 2019, 2020).

Given evidence of parallels between the dissociative symptoms of depersonalization and derealization with the DSM-5 symptoms of PTSD (Cramer et al., 2020), it is not surprising therefore that pathological dissociation has been found to involve a parallel fragmentation of the self that involves a profound functional disconnection between essential systems in the brain involved in self-awareness, conscious thought, and threat detection (Lebois et al., 2021, 2022; A. A. Reinders et al., 2014). In extreme cases of dissociative fragmentation of the self, dissociative identity disorder, diminution of the surface area and thickness of brain cortices involved in self-regulation/integrity has been observed (A. Reinders et al., 2018), as well as diminished prefrontal parietal functional activation in trauma-related self-states compared to DID simulators or healthy and PTSD controls (Vissia et al., 2022). However, compared to healthy controls, no differences were found among individuals with DID in the volume of a brain area that has consistently been identified as involved in PTSD, the amygdala (A. Reinders et al., 2022)—suggesting a potential biological divergence between dissociative and other posttraumatic disorders.

Thus, despite major advancements in our understanding the multiplicity of ways in which posttraumatic fragmentation of experience and of self occurs, and co-occur, and the psychobiological underpinnings and manifestations of post-traumatic dissociative adaptations and pathology, many complexities remain to be defined and unraveled. Achieving increased specificity and clarity in the foundational principles and processes involved in complex psychological trauma and pathological dissociation is absolutely essential for accurate and effective clinical assessment and treatment of complex trauma survivors, and to informing and integrating their trauma-focused (Ford, 2018; Stavropoulos & Elliott, 2023) and dissociation-focused (Brand et al., 2019; Myrick et al., 2017) treatment.

This is far from the first call to action along these lines in our field, but I hope it will encourage JTD’s readers to carefully reflect on what we have yet to learn about complex trauma and dissociation – and how you might contribute to the knowledge base. In addition to considering JTD as a venue to publish quantitative research studies, here are other ways to do this as a JTD author that I strongly encourage.

Although relatively rare in the past, several systematic reviews and meta-analyses on complex trauma, dissociation, and their assessment, comorbidities, and treatment have been or are being published by JTD recently (e.g. (Atchley & Bedford, 2021; Hamer et al., 2023; Sideli et al., 2023; Yeates et al., 2023). I am working with JTD’s Associate Editors and Editorial Board members and potential authors to develop special issues and systematic reviews and meta-analyses, with the goal of addressing each of the essential topics identified in the landmark compendium Dissociation and the Dissociative Disorders: Past, Present, Future, 2^nd Edition (Dorahy et al., 2023). I envision this becoming a regular series entitled Practitioner and Researcher Updates on Emerging and Foundational Issues in Complex Trauma and Dissociation.

Empiricism tends to be equated with scientific research and quantitative statistical analyses and meta-analyses, but clinical case studies, qualitative and grounded theory research, and policy analyses, among others, are also vital ways to report rigorous empirical observations and their implications.

JTD has not published many clinical case reports, but those that have been featured in JTD have been timely and illuminating, both historically (Ross, 2008) and recently (Colbert, 2023). Case reports provide a unique window into the lived experience of persons in recovery from complex trauma and dissociative disorders and the challenges they and their clinicians face in assessment and treatment. Observations and reflections of clinicians in practice are an invaluable role model, as well as a key source of evidence regarding the nuances of putting empirically informed treatment into practice. Case reports enable us get inside the mind and see through the eyes of real-world clinicians – and even to unpack the moment-to-moment processes involved in delivering evidence-based treatment and learn ways to actually develop a working alliance, conduct assessment and case conceptualization, collaboratively plan and provide treatment, and respond to the unexpected and to crises as therapy unfolds. As an example, a series of case study webinars have been produced by the Center for the Treatment of Developmental Trauma Disorders, with films of therapists handling crises in dramatized (but extremely true to life) treatment sessions with youths and families. The series, “Identifying Critical Moments and Healing Complex Trauma” can be accessed via the Learning Center of the National Child Traumatic Stress Network (Learn.nctsn.org). The webinars also include therapist reflections, expert commentary and case conferences in order to highlight key learning points. In that same spirit, JTD will establish a Complex Trauma and Dissociation Case Studies series to actively encourage the submission of case study articles – with careful attention to the protection of privacy and safety of all clients involved – with each case report to be accompanied by commentary from therapists of diverse backgrounds and approaches to treatment.

Grounded theory (Hall, 2022) and qualitative research (Sandole & Auerbach, 2013) also have had and will continue to have, an important place in the JTD portfolio. These investigations are essential to complement and extend quantitative studies on the key question of how to define and conceptualize complex psychological trauma (Ford, 2023b; Jowett et al., 2021) and pathological dissociation (Dell, 2019; Van der Hart & Dorahy, 2023), as well as how to effectively and collaboratively treat complex trauma survivors in recovery from dissociative pathology (Brand & Stadnik, 2013; Myrick et al., 2015) and related high-risk comorbidities (Ford & Courtois, 2021; Ford & Gomez, 2015; Israel et al., 2024).

Policy analyses have been the focus for several important recent JTD editorials and Special Issues on institutional and societal betrayal (Filippaki & Salter, 2021; Holland & Barnes, 2019; McCauley et al., 2023; Salter & Blizard, 2022). Translating science into action (DePrince, 2022) and engaging researchers in support of emerging social issues and advocacy (Cook et al., 2020) are critical priorities that all too rarely are highlighted in professional journals – but have been a mainstay of JTD. For a Journal such as JTD the outcomes are published articles that make a meaningful contribution to society as well as to the knowledge of its readers. For that reason, I also asked two colleagues whose work focuses on trauma and dissociation in under-served populations and communities of color to develop the first Special Issue launched under my editorship with a focus on the intersection of racial and identity-based disparities and marginalization with dissociation. They, bring great expertise to this Special Issue, as both have served as guest editors on Special Issues on the intersection of discrimination, disparities, and trauma in marginalized communities, for JTD (Gomez et al., 2021) and for the Journal of Traumatic Stress (Allwood et al., 2021). And they will be joined by a third guest editor, David Archer, who is committed to serving the needs of under-served populations as an author of several books and an anti-racist psychotherapist.

Lastly, in order to extend the Journal’s role as a catalyst for the next generations of clinical researchers and clinicians globally, I plan to develop initiatives highlighting: (1) the work of early career researchers and practitioners, to engage them as ongoing participants and future leaders in ISSTD and the Journal, and (2) research and clinical innovations from rapidly emerging and under-represented global regions (e.g., China, India, Africa, South America). Please consider how you might contribute to these, and the aforementioned initiatives, so that together we can ensure JTD’s success as a leader in advancing knowledge, practice, and policy related to complex psychological trauma and dissociation.