Single Paper or Case Study

Dissociation and Shame: The Plight of Patients with DID with High-Functioning Self-States

Sunday, March 25
1:50 PM - 2:10 PM
Location: Wilson


This paper illustrates the quandry for patients with D.I.D with high-functioning capacities/states, either in work, intellectually and/or in their life achievements. It poses the question whether such abilities actually impede recovery due to increased shame in the diagnosis and in having much less functional altered parts. 


The author presents anonymised single case studies of three patients with D.I.D in treatment where the sense of shame/stigma and high levels of functionality in certain alters appear to be highly correlatory factors.

Main Points

This paper draws on the author's clinical experience over more than 20 years in the area complex trauma and dissociation, specialising in the dissociative disorders since 2009. The paper uses rich clinical material to illustrate the intensity of humilation and concealment displayed by these 'high functioning' patients, together with their wish to avoid 'multi-gration' and thereby risk losing their areas of functionality. The paper raises the question whether such patients are thus more intractable and less likely to recover than those with less highly functioning self-states.


The author concludes that the subject of 'high functioning', shame and D.I.D. warrants further clinical and theoretical writing and empircal research.



Main points


Learning Objectives:

Rachel C. Thomas

Clinic for Dissociative Studies, London, UK (CDS UK)
London, England

I am a Consultant Clinical Psychologist with nearly 18 years of post-qualification experience in Clinical Psychology, having qualified from the South Thames doctoral program, London, UK, in 2000 following four-year training. In addition, I am a qualified Consultant Adult Psychoanalytic Psychotherapist, having undertaken a further post-qualification training at the Tavistock Centre in Adult Psychotherapy (2004-8).

I worked at the Tavistock Centre, London, UK, as a Consultant Psychologist and Psychotherapist for nearly 10 years (2004-14) within their Adult Directorate. For the duration of this period, I was a senior clinician in the Tavistock Clinic's specialist Trauma Unit and worked additionally with many complex adult patients with significant psychiatric morbidity.

In March 2014, I left my post at the Tavistock to take up the role of Clinical Lead and Director Elect for the Clinic for Dissociative Studies, UK, a well-reputed and specialised, NHS-funded, national trauma clinic working with survivors of extreme trauma and dissociative disorders in the UK. I became Director of the Clinic in January 2017 upon the retirement of my predecessor and the Clinic's founder, Dr Valerie Sinason.

I have also been working as an Expert Witness in complex trauma since 2002 and have prepared several hundred reports for court connected to the psychological and psychiatric condition of traumatised asylum seekers. I have received a number of commendations for my reports from the UK immigration tribunals for this work.


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Dissociation and Shame: The Plight of Patients with DID with High-Functioning Self-States

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