Hallings-Pott, Charlie; (2003) The role of threat in triggering disassociation in bulimic disorders. Doctoral thesis (D.Clin.Psy), UCL (University College London).

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Abstract

Background: Dissociation is commonly found as a trait in women with bulimic disorders, where it appears to serve the function of lowering awareness of generalised threat and negative self-esteem. This experimental study assesses whether dissociation is a reactive state in bulimic women, as well as a trait. This study tests the hypothesis that threat cues will trigger dissociation within a bulimic population. The literature indicates that activation of negative affect (especially related to the activation of abandonment schemas) is related to levels of bulimic pathology and to the triggering of symptoms. A second hypothesis examined the impact of threat on state affect. Methods: Participants were 24 bulimic and 26 non-clinical women. Each completed the Eating Disorders Inventory (EDI) and the Dissociative Experiences Scale (DES-II), and was exposed to a subliminal neutral cue and a subliminal threat cue (order counterbalanced). After each cue, they completed the subjective component of the Clinician-Administered Dissociation Scale (CADSS) and a measure of anxiety and mood (Hospital Anxiety and Depression Scale - HADS). Results: The subliminal threat cue had no effect on the non-clinical group, but the threat cue significantly increased state dissociation (particularly derealisation levels) in the bulimic women. There was no impact on mood. There were no significant associations of dissociative reactivity with trait dissociation or with any aspect of eating pathology. Discussion: In the bulimic eating disorders, state dissociation is particularly susceptible to the impact of threat cues, even when they are presented below the level of conscious awareness. This finding might explain a number of clinical phenomena, including difficulties in the therapeutic relationship. Future research is needed to extend this finding.

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