The majority of patients treated with psychotherapy for PTSD in randomized trials recover or improve, rendering these approaches some of the most effective psychosocial treatments devised to date. Several caveats, however, are important in applying these findings to patients treated in the community. Exclusion criteria and failure to address polysymptomatic presentations render generalizability to the population of PTSD patients indeterminate. The majority of patients posttreatment continue to have substantial residual symptoms, and follow-up data beyond very brief intervals have been largely absent. Future research intended to generalize to patients in practice should avoid exclusion criteria other than those a sensible clinician would impose in practice (e.g., schizophrenia), should avoid wait-list and other relatively inert control conditions, and should follow patients through at least 2 years.

Effect sizes for psychosocial treatments for illicit drugs ranged from the low-moderate to high-moderate range, depending on the substance disorder and treatment under study. Given the long-term social, emotional, and cognitive impairments associated with substance use disorders, these effect sizes are noteworthy and comparable to those for other efficacious treatments in psychiatry.

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In 1997, Putnam [1] pointed out that relatively little was known about the etiology and development of dissociation other than the presumed etiologic role of trauma; however, the fact that nontraumatized individuals sometimes demonstrated dissociation and that not all trauma survivors dissociate suggested that there may be more to the etiology and development of dissociation than trauma alone. Putnam [1] explored the role of various potential moderating variables including age, sex, culture, genetic factors, and education/intelligence in the development of dissociation, and although moderating trends were found for some of these variables, existing research has not convincingly demonstrated that any of these variables significantly influence dissociation.Family environmental factors, however, are the one set of factors that have been most consistently related to dissociation. Factors such as inconsistent parenting or disciplining, [2-4] level of family risk [5], and parental dissociation, as measured by the Dissociative Experiences Scale [6], have been shown to be associated significantly with higher levels of dissociation in adulthood. Most available research on dissociation, however, has focused on trauma, leaving many unanswered questions regarding how other family factors intersect with familial abuse in the developmental trajectories leading to dissociative disorders.Barach [7] was one of the first theorists to connect dissociation with attachment theory. In his article, Barach [7] suggested that multiple personality disorder (now known as dissociative identity disorder) was a variant of an "attachment disorder." He pointed out that individuals who had this disorder tended to demonstrate the extreme detachment, or emotional unresponsiveness, experienced by children faced with a loss of their primary caretaker, as described by Bowlby [8]. Barach [7] further suggested that children of unresponsive caretakers were also likely to engage in dissociative or "detached" behaviors. As one offshoot of attachment studies, developmental theorists and researchers have begun to explore the role of early childhood attachment and parenting in the etiology and development of dissociative symptomatology.Liotti's [9] theorizing has more specifically implicated disorganized patterns of infant attachment behavior as potential precursors to the development of dissociation later in life. He pointed out that there are parallels between infant disorganization and dissociation. Both phenomena reflect a pervasive lack of behavioral or mental integration. This primary failure of integration in infancy may result in vulnerability to dissociative organization of mental life

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The aim of this study was to assess the reliability and validity of the Child Behavior Checklist (CBCL) as completed by doctoral-level clinicians in the treatment of adolescents. We asked 294 randomly selected, experienced psychiatrists and psychologists to describe a patient aged 14 to 18 in treatment for personality pathology. Clinicians completed the CBCL (parent-report version) and measures of adaptive functioning, personality pathology, and family and developmental history, which served as criterion variables to test the validity of the CBCL as completed by clinicians. Most CBCL scales demonstrated acceptable reliability. Validity estimates were impressive, and the data revealed clinically meaningful associations between specific CBCL scale scores and developmental and family history variables. Confirmatory factor analysis showed that the factorial structure of the clinician-report CBCL resembled that of the parent-report CBCL, with the exception of a substantially lower correlation between higher order internalizing and externalizing factors. The data suggest that clinical judgment can be both reliable and valid when quantified using psychometrically sound instruments.

Kihlstrom (2005) has recently called attention to the need for prospective longitudinal studies of dissociation. The present study assesses quality of early care and childhood trauma as predictors of dissociation in a sample of fifty-six low income young adults followed from infancy to age 19. Dissociation was assessed with the Dissociative Experiences Scale; quality of early care was assessed by observer ratings of mother-infant interaction at home and in the lab; and childhood trauma was indexed by state-documented maltreatment, self-report, and interviewer ratings of participants’ narratives. Regression analysis indicated that dissociation in young adulthood was significantly predicted by observed lack of parental responsiveness in infancy, while childhood verbal abuse was the only type of trauma that added to the prediction of dissociation. Implications are discussed in the context of previous prospective work also pointing to the important contribution of parental emotional unresponsiveness in the development of dissociation.