The Four-Dimensional (4-D) Model as a Framework for Understanding Trauma-Related Dissociation

This chapter summarizes our clinical-theoretical perspective on dissociative experiences formalized as the Four-Dimensional (4-D) Model of Trauma-related Dissociation, which emphasizes dissociative experiences occurring with respect to experiences of time, thought, body, and emotion. First, we overview the theoretical background to the 4-D model and how it compares with other theories and definitions of dissociative experiences that emphasize trauma-related altered states of consciousness (TRASC), compartmentalization, or structural dissociation of the personality. Second, we find broad support for four predictions associated with the 4-D model based on a systematic review of extant literature. That is, symptoms of TRASC, when compared with symptoms of distress that do not fall outside the domain of normal waking consciousness (NWC), tend to be endorsed less frequently, co-endorsed less frequently, and more strongly correlated with other measures of dissociative experiences and childhood trauma history. Third, we make brief reference to recent neuroimaging studies of dissociation, and remark on the apparent consistency between the 4-D model and how dissociative disorders and the D-PTSD subtype are currently diagnosed under DSM-5. Finally, the chapter briefly considers some of the treatment implications of the 4-D model, particularly for augmenting psychotherapy by neuroscience-informed treatments.