This article provides a brief overview on the outcomes of ACEs (Adverse Childhood Experiences) with respect to dissociative symptoms and attachment disorders.

Background:  Adverse Childhood Experiences, extreme stress, and dissociative symptoms

There is considerable evidence regarding the relationship between childhood abuse or neglect and dissociation symptoms in adulthood with an earlier age of onset, as well as a longer duration of abuse and parental abuse significantly predicted higher dissociation scores.

The relationship between ACEs and dissociation is fully mediated by mentalization; this means that the important predictive factor for dissociation is not if you have been abused as a child, but rather how this abuse or neglect influenced your mentalization capabilities (Wagner-Skacel et al., 2022).

Attachment theory and spirit possession

Many individuals ask us if we work with spirit attachment.  The answer is very consistent. Several points are worth highlighting here based on existing evidence:

  • As discussed above, trauma plays a strong role in personality disorders and dissociative identity disorders
  • Dissociation is a mental process which allows an individual to tolerate distressed events by splitting off highly incoherent or overwhelming thoughts, memories and feelings (Wagner-Skacel et al., 2022)..
  • Spirit possession is a common dissociative phenomenon, manifesting not only in African, Asian and Caribbean countries but also in Europe and North America(van Duijl et al., 2010).
  • Globally, several experts have concluded the role of potentially traumatizing events in predicting dissociative symptomatology, especially when the events are severe and recurrent.

Dissociative DisorderThis is not very different from our research on chronic disease and infectious disease risk (Ramani et al., 2022; G. Trivedi et al., 2018; G. Y. Trivedi & Saboo, 2020).  The research indicated that lifestyle choices are linked to increased risk not only for chronic disease but also for infectious disease.  Moreover, this risk between lifestyle choices and the disease likelihood is not quantifiable to a specific lifestyle choice.  The work on dissociative symptoms, spirit attachment and entity is – in general – very similar with trauma (especially, high intensity, repeated nature) at the core of the intermediate condition (dissociation) or even Post Traumatic Stress Disorder (PTSD) or Borderline Personality Disorder (van Duijl et al., 2010; Wagner-Skacel et al., 2022). Because of these reasons, the spirit attachment or increased risk of attack for infection (compared to other healthy, low stress human being) is more likely to happen for the individuals who have experienced extreme stress.

What’s the implications for therapy?

The evidence on dissociative states and their role in outcomes such as spirit attachment or attachment challenges indicates that the core to these symptoms is dissociative state. Above evidence has also highlighted that dissociative state is one of the likely outcomes of extreme trauma.  Therefore, our work focuses primarily on the trauma history including the risks associated with lifestyle choices (incl. the assessment of stress). Many of these individuals are likely to be more stress, less resilient (emotionally) to external events.  This is very similar to the layers of complexity introduced by the idea of PTSD and Complex PTSD where DESNOS (‘Disorders of Extreme Stress-Not otherwise specified’) is one of the core elements (Maercker, 2021).


To summarize, all the complex outcomes ranging from functional impairment (in Complex PTSD), Dissociative disorder, or the core 6 symptoms of PTSD are linked to extreme stress caused (or perceived) by traumatic experiences.  To better identify the presence of trauma or its intermediate symptoms, we measure Adverse Childhood Experiences ((G. Y. Trivedi et al., 2021)) and several mental health parameters (G. Y. Trivedi & Trivedi, 2020).  Together, these measures provide us a powerful framework to work on any complex presenting problem or outcome.  For example, individuals who are extremely stressed may indicate very poor wellbeing and high anxiety (or depression) levels.  This is often accompanied by sleep quality issues. Hence, even if they haven’t highlighted any ACEs, we are able to identify an underlying (extreme) stress that helps us go to the root cause of the problem.

Highlights from the Nature Review article: Mentalization and dissociation after adverse childhood experiences

“Internalized traumatic early experiences (as often the case when experiencing ACEs) may lead to corresponding working models and obstructions in the functional regulation of emotions with less flexibility and more adaptive personality patterns. Overcontrol of emotions such as in the dissociative subtype of PTSD need effective treatments as fostering mentalizing with a top-down regulation and strengthening the individual’s capacity to feel and to simultaneously reflect on his or her feelings.”

“The relationship between ACEs and dissociation is fully mediated by mentalization; this means than the important predictive factor for dissociation is not if you have been abused as a child, but rather how this abuse or neglect influenced your mentalization capabilities.” 

Source: (Wagner-Skacel et al., 2022) in Scientific Reports (Nature).


Maercker, A. (2021). Development of the new CPTSD diagnosis for ICD-11. Borderline Personality Disorder and Emotion Dysregulation, 8(1), 7.

Ramani, P. K., Ramani, H., Trivedi, G. Y., P, V., M, L., & Verma, A. (2022). Preventing Insidious Lifestyle Diseases. Bookventures.

Trivedi, G., Hemalatha, R., & KV, R. (2018). Chronic Diseases and Mind -Body Management, Part 1—An Introduction (Technical Note No. CMHS0044TEC). IIMA.

Trivedi, G. Y., Pillai, N., & Trivedi, R. G. (2021). Adverse Childhood Experiences & mental health – the urgent need for public health intervention in India. Journal of Preventive Medicine and Hygiene, 62(3), E728–E728.

Trivedi, G. Y., & Saboo, B. (2020). The Risk Factors for Immune System Impairment and the Need for Lifestyle Changes. Journal of Social Health and Diabetes, EFirst.


van Duijl, M., Nijenhuis, E., Komproe, I. H., Gernaat, H. B. P. E., & de Jong, J. T. (2010). Dissociative Symptoms and Reported Trauma Among Patients with Spirit Possession and Matched Healthy Controls in Uganda. Culture, Medicine, and Psychiatry, 34(2), 380–400.

Wagner-Skacel, J., Riedl, D., Kampling, H., & Lampe, A. (2022). Mentalization and dissociation after adverse childhood experiences. Scientific Reports, 12(1), 6809.