Revisiting the role of verbal suggestion in dissociative psychopathology

Dissociative symptoms, which are characterised by a disruption between normally integrated cognitive-perceptual systems, and suggestion effects, such as changes in awareness, perception and behaviour in response to verbal suggestions, are historically intertwined and long believed to share a family resemblance.1 This association continues to figure prominently in contemporary debates regarding the aetiology of dissociative psychopathology with prominent theories diverging regarding aberrant suggestibility in the dissociative disorders. The sociocognitive model proposes that greater responsiveness to suggestion (suggestibility) among dissociative disorder patients facilitates false memories of trauma through an admixture of processes including iatrogenesis and responsiveness to sociocultural cues (Figure 1a). By contrast, the trauma model maintains that dissociation functions as a coping response to traumatic stress that progresses to psychopathology in certain individuals independently of suggestion (Figure 1b). Proponents of the sociocognitive model have recently conceded that suggestibility is not strongly related to dissociation, intimating a potential emerging consensus. Irrespective of the merits of these models, here we correct the record on responsiveness to suggestion in dissociative psychopathology.