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Lanfranco RC, Martínez-Aguayo JC, Arancibia M. Assessing malingering and personality styles in dissociative identity disorder: a case study. Neurocase 2023; 29:141-150. [PMID: 38704614 DOI: 10.1080/13554794.2024.2348218] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/28/2022] [Accepted: 04/15/2024] [Indexed: 05/06/2024]
Abstract
Dissociative Identity Disorder (DID), formerly Multiple Personality Disorder, involves two or more distinct identities controlling behaviour, stemming from trauma-related dissociation. Understanding DID's cognitive, neural, and psychometric aspects remains a challenge, especially in distinguishing genuine cases from malingering. We present a case of a DID patient with nine identities, evaluated to rule out malingering. Using the Millon Index of Personality Styles, we assessed the primary and two alternate identities, revealing marked differences. High consistency scores support validity. We suggest employing personality inventories beyond symptomatology to characterise dissociative identities' consistency and adaptation styles, aiding in malingering assessments in future studies.
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Affiliation(s)
- Renzo C Lanfranco
- Department of Neuroscience, Karolinska Institutet, Stockholm, Sweden
- Department of Psychology, University of Edinburgh, Edinburgh, UK
- Center for Research in Cognition & Neurosciences, Université libre de Bruxelles, Brussels, Belgium
| | | | - Marcelo Arancibia
- Center of Translational Studies in Stress and Mental Health (C-ESTRES), Faculty of Sciences, Universidad de Valparaíso, Valparaíso, Chile
- Department of Psychiatry, School of Medicine, Faculty of Medicine, Universidad de Valparaíso, Valparaíso, Chile
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2
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Vissia EM, Lawrence AJ, Chalavi S, Giesen ME, Draijer N, Nijenhuis ERS, Aleman A, Veltman DJ, Reinders AATS. Dissociative identity state-dependent working memory in dissociative identity disorder: a controlled functional magnetic resonance imaging study. BJPsych Open 2022; 8:e82. [PMID: 35403592 PMCID: PMC9059616 DOI: 10.1192/bjo.2022.22] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/22/2023] Open
Abstract
BACKGROUND Memory function is at the core of the psychopathology of dissociative identity disorder (DID), but little is known about its psychobiological correlates. AIMS This study aims to investigate whether memory function in DID differs between dissociative identity states. METHOD Behavioural data and neural activation patterns were assessed in 92 sessions during an n-back working memory task. Participants were people with genuine diagnosed DID (n = 14), DID-simulating controls (n = 16) and a paired control group (post-traumatic stress disorder (n = 16), healthy controls (n = 16)). Both DID groups participated as authentic or simulated neutral and trauma-related identity states. Reaction times and errors of omission were analysed with repeated measures ANOVA. Working memory neural activation (main working memory and linear load) was investigated for effects of identity state, participant group and their interaction. RESULTS Identity state-dependent behavioural performance and neural activation was found. DID simulators made fewer errors of omission than those with genuine DID. Regarding the prefrontal parietal network, main working memory in the left frontal pole and ventrolateral prefrontal cortex (Brodmann area 44) was activated in all three simulated neutral states, and in trauma-related identity states of DID simulators, but not those with genuine DID or post-traumatic stress disorder; for linear load, trauma-related identity states of those with genuine DID did not engage the parietal regions. CONCLUSIONS Behavioural performance and neural activation patterns related to working memory in DID are dependent on the dissociative identities involved. The narrowed consciousness of trauma-related identity states, with a proneness to re-experiencing traumatising events, may relate to poorer working memory functioning.
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Affiliation(s)
- Eline M Vissia
- Cognitive Neuroscience Centre, University Medical Centre Groningen, University of Groningen, The Netherlands; and Centre for Psychotrauma, Heelzorg, The Netherlands
| | - Andrew J Lawrence
- Department of Psychological Medicine, Institute of Psychiatry, Psychology & Neuroscience, King's College London, UK
| | - Sima Chalavi
- Cognitive Neuroscience Centre, University Medical Centre Groningen, University of Groningen, The Netherlands; and Research Centre for Movement Control and Neuroplasticity, Department of Movement Sciences, Katholieke Universiteit Leuven, Belgium
| | - Mechteld E Giesen
- Cognitive Neuroscience Centre, University Medical Centre Groningen, University of Groningen, The Netherlands
| | - Nel Draijer
- Department of Psychiatry, VU University Medical Center, Amsterdam University Medical Center, The Netherlands
| | | | - André Aleman
- Cognitive Neuroscience Centre, University Medical Centre Groningen, University of Groningen, The Netherlands
| | - Dick J Veltman
- Department of Psychiatry, VU University Medical Center, Amsterdam University Medical Center, The Netherlands
| | - Antje A T S Reinders
- Cognitive Neuroscience Centre, University Medical Centre Groningen, University of Groningen, The Netherlands; and Department of Psychological Medicine, Institute of Psychiatry, Psychology & Neuroscience, King's College London, UK
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3
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A Critical Analysis of Myths About Dissociative Identity Disorder. ANNALES MEDICO-PSYCHOLOGIQUES 2021. [DOI: 10.1016/j.amp.2021.10.007] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
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Marsh RJ, Dorahy MJ, Butler C, Middleton W, de Jong PJ, Kemp S, Huntjens R. Inter-identity amnesia for neutral episodic self-referential and autobiographical memory in Dissociative Identity Disorder: An assessment of recall and recognition. PLoS One 2021; 16:e0245849. [PMID: 33577556 PMCID: PMC7880432 DOI: 10.1371/journal.pone.0245849] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2020] [Accepted: 01/09/2021] [Indexed: 11/18/2022] Open
Abstract
Amnesia is a core diagnostic criterion for Dissociative Identity Disorder (DID), however previous research has indicated memory transfer. As DID has been conceptualised as being a disorder of distinct identities, in this experiment, behavioral tasks were used to assess the nature of amnesia for episodic 1) self-referential and 2) autobiographical memories across identities. Nineteen DID participants, 16 DID simulators, 21 partial information, and 20 full information comparison participants from the general population were recruited. In the first study, participants were presented with two vignettes (DID and simulator participants received one in each of two identities) and asked to imagine themselves in the situations outlined. The second study used a similar methodology but with tasks assessing autobiographical experience. Subjectively, all DID participants reported amnesia for events that occurred in the other identity. On free recall and recognition tasks they presented a memory profile of amnesia similar to simulators instructed to feign amnesia and partial information comparisons. Yet, on tests of recognition, DID participants recognized significantly more of the event that occurred in another identity than simulator and partial information comparisons. As such, results indicate that the DID performance profile was not accounted for by true or feigned amnesia, lending support to the idea that reported amnesia may be more of a perceived than actual memory impairment.
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Affiliation(s)
- Rosemary J. Marsh
- School of Psychology, Speech and Hearing, University of Canterbury, Canterbury, New Zealand
- Department of Clinical Psychology, University of Groningen, Groningen, Netherlands
| | - Martin J. Dorahy
- School of Psychology, Speech and Hearing, University of Canterbury, Canterbury, New Zealand
- The Cannan Institute, Belmont Private Hospital, Brisbane, Australia
- * E-mail:
| | - Chandele Butler
- School of Psychology, Speech and Hearing, University of Canterbury, Canterbury, New Zealand
| | - Warwick Middleton
- School of Psychology, Speech and Hearing, University of Canterbury, Canterbury, New Zealand
- The Cannan Institute, Belmont Private Hospital, Brisbane, Australia
| | - Peter J. de Jong
- Department of Clinical Psychology, University of Groningen, Groningen, Netherlands
| | - Simon Kemp
- School of Psychology, Speech and Hearing, University of Canterbury, Canterbury, New Zealand
| | - Rafaele Huntjens
- Department of Clinical Psychology, University of Groningen, Groningen, Netherlands
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Huntjens RJC, Rijkeboer MM, Arntz A. Schematherapy in DID: treatment length and related studies on dissociative amnesia. Eur J Psychotraumatol 2020; 11:1711638. [PMID: 32002144 PMCID: PMC6968667 DOI: 10.1080/20008198.2020.1711638] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/25/2022] Open
Affiliation(s)
- R J C Huntjens
- Department of Experimental Psychotherapy and Psychopathology, University of Groningen, Groningen, Netherlands
| | - M M Rijkeboer
- Department of Clinical Psychological Science, Maastricht University, Maastricht, Netherlands
| | - A Arntz
- Department of Clinical Psychology, University of Amsterdam, Amsterdam, Netherlands
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Caputo GB. Strange-face illusions during eye-to-eye gazing in dyads: specific effects on derealization, depersonalization and dissociative identity. J Trauma Dissociation 2019; 20:420-444. [PMID: 30938658 DOI: 10.1080/15299732.2019.1597807] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
Experimentally induced strange-face illusions can be perceived when two individuals look at each other in the eyes under low illumination for about 10 minutes. This task of subject-other eye-to-eye gazing produces the following perceptions by the subject: (i) mild to huge deformations and color/shape changes of face and facial features; (ii) lifeless, unmoving faces and immaterial presences akin to out-of-body experiences; (iii) pseudo-hallucinations, enlightened 'idealized' faces and personalities - rather than the other's actual face. Dissociative phenomena seem to be involved, whereas the effects of non-pathological dissociation on strange-face illusions have not yet been directly investigated. In the present study, dissociative perceptions and strange-face illusions were measured through self-report questionnaires on a large sample (N = 90) of healthy young individuals. Results of correlation and factor analyses suggest that strange-face illusions can involve, respectively: (i) strange-face illusions correlated to derealization; (ii) strange-face illusions correlated to depersonalization; and (iii) strange-face illusions of identity, which are supposedly correlated to identity dissociation. The findings support the separation between detachment and compartmentalization in dissociative processes. Effects of gender show that strange-face illusions are more frequent in men with respect to women if dyads are composed of individuals of different-gender. Furthermore, drawings of strange-faces, which were perceived by portrait artists in place the others' faces, allowed a direct illustration of examples of dissociative identities. Findings are discussed in relation to the three-level model of self-referential processing.
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Huntjens RJC, Rijkeboer MM, Arntz A. Schema therapy for Dissociative Identity Disorder (DID): rationale and study protocol. Eur J Psychotraumatol 2019; 10:1571377. [PMID: 30815233 PMCID: PMC6383624 DOI: 10.1080/20008198.2019.1571377] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/19/2018] [Revised: 12/23/2018] [Accepted: 01/06/2019] [Indexed: 12/24/2022] Open
Abstract
Background: A category of disorders frequently associated with a history of trauma are the dissociative disorders, of which Dissociative Identity Disorder (DID) is the most severe and chronic form. DID is associated with high levels of impairment, treatment utilization, and treatment costs, yet systematic research into treatment effects is scarce. Practice-based clinical guidelines advise a phase-based approach which is lengthy and has rather high reported dropout rates. Therefore, in the current proposal the efficacy of an alternative treatment for DID (i.e. schema therapy) is tested. Objective: The aim of this study is to critically test the effectiveness of schema therapy for DID patients, for whom at present no evidence-based treatment is available. Method: In light of the low prevalence of DID, and the proposed treatment length of three years, a case series experimental approach is used (non-concurrent multiple baseline design). Ten outpatients are included, who are diagnosed with DID by an independent rater using the Structured Clinical Interview for DSM-IV Dissociative Disorders (SCID-D-R), which is double-checked by another independent expert. Primary outcomes are a (bi)weekly assessed state measure of dissociative symptoms, a pre-, post- and follow-up measure of the presence of the DID diagnosis, and drop-out rate. Secondary outcomes include various measures of trait dissociative symptoms, comorbid symptomatology, and global symptomatic distress. Trial registration: Netherlands Trial Register (NTR): NTR4496.
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Affiliation(s)
- Rafaële J. C. Huntjens
- Department of Experimental Psychotherapy and Psychopathology, University of Groningen, Groningen, the Netherlands
| | - Marleen M. Rijkeboer
- Department of Clinical Psychological Science, Maastricht University, Maastricht, the Netherlands
| | - Arnoud Arntz
- Department of Clinical Psychology, University of Amsterdam, Amsterdam, the Netherlands
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8
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Abstract
Dissociative identity disorder is characterised by the presence in one individual of two or more alternative personality states (alters). For such individuals, the memory representation of a particular event can have full episodic, autonoetic status for one alter, while having the status of knowledge or even being inaccessible to a second alter. This phenomenon appears to create difficulties for a purely representational theory and is presented to Mahr & Csibra (M&C) for their consideration.
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Abstract
INTRODUCTION Patients diagnosed with dissociative identity disorder (DID) usually present with alternative personality states (alters) who take separate control of consciousness. Commonly, one alter will claim they have no awareness of events which took place when another alter was in control. However, some kinds of material are transferred across the alter boundary. Huntjens et al. devised an objective method of demonstrating such transfer. METHODS In the main study, following Huntjens et al., for three patients, two alters were taught different sets of nouns. The following week, one of the alters was given a recognition memory test including both sets plus distractor words. The patients in the Huntjens experiment responded in the same way to words in both sets. RESULTS In the present experiemnt, two of the patients tested had pairs of alters where there was no interference from the material which was presented to the other alter. In one of these cases, there was breakthrough with one pairing of alters, a pattern matched in a subsidiary experiment. CONCLUSIONS The population of individuals with DID are not homogeneous with respect to the depth of the blocking of episodic material from one alter to another.
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Affiliation(s)
- John Morton
- a Institute of Cognitive Neuroscience, University College , London , UK
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10
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Nijenhuis ER. Ten reasons for conceiving and classifying posttraumatic stress disorder as a dissociative disorder. EUROPEAN JOURNAL OF TRAUMA & DISSOCIATION 2017. [DOI: 10.1016/j.ejtd.2017.01.001] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
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Trauma-related self-defining memories and future goals in Dissociative Identity Disorder. Behav Res Ther 2016; 87:216-224. [PMID: 27770748 DOI: 10.1016/j.brat.2016.10.002] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2016] [Revised: 10/04/2016] [Accepted: 10/10/2016] [Indexed: 11/21/2022]
Abstract
This study examined the content of self-defining autobiographical memories in different identities in patients with Dissociative Identity Disorder (DID) and comparison groups of patients with PTSD, healthy controls, and DID simulators. Consistent with the DID trauma model, analyses of objective ratings showed that DID patients in trauma identities retrieved more negative and trauma-related self-defining memories than DID patients in avoidant identities. Inconsistent with the DID trauma model, DID patients' self-rated trauma-relatedness of self-defining memories and future life goals did not differ between trauma identities and trauma avoidant identities. That is, the DID patients did not seem to be "shut off" from their trauma while in their avoidant identity. Furthermore, DID patients in both identities reported a higher proportion of avoidance goals compared to PTSD patients, with the latter group scoring comparably to healthy controls. The simulators behaved according to the instructions to respond differently in each identity (i.e., to report memories and goals consistent with the identity tested). The discrepant task behavior by DID patients and simulators indicated that DID patients did not seem to intentionally produce the hypothesized differences in performance between identities. In conclusion, for patients with DID (i.e., in both identities) and patients with PTSD, trauma played a central role in the retrieval of self-defining memories and in the formulation of life goals.
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Dorahy MJ, Brand BL, Sar V, Krüger C, Stavropoulos P, Martínez-Taboas A, Lewis-Fernández R, Middleton W. Dissociative identity disorder: An empirical overview. Aust N Z J Psychiatry 2014; 48:402-17. [PMID: 24788904 DOI: 10.1177/0004867414527523] [Citation(s) in RCA: 93] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
OBJECTIVE Despite its long and auspicious place in the history of psychiatry, dissociative identity disorder (DID) has been associated with controversy. This paper aims to examine the empirical data related to DID and outline the contextual challenges to its scientific investigation. METHODS The overview is limited to DID-specific research in which one or more of the following conditions are met: (i) a sample of participants with DID was systematically investigated, (ii) psychometrically-sound measures were utilised, (iii) comparisons were made with other samples, (iv) DID was differentiated from other disorders, including other dissociative disorders, (v) extraneous variables were controlled or (vi) DID diagnosis was confirmed. Following an examination of challenges to research, data are organised around the validity and phenomenology of DID, its aetiology and epidemiology, the neurobiological and cognitive correlates of the disorder, and finally its treatment. RESULTS DID was found to be a complex yet valid disorder across a range of markers. It can be accurately discriminated from other disorders, especially when structured diagnostic interviews assess identity alterations and amnesia. DID is aetiologically associated with a complex combination of developmental and cultural factors, including severe childhood relational trauma. The prevalence of DID appears highest in emergency psychiatric settings and affects approximately 1% of the general population. Psychobiological studies are beginning to identify clear correlates of DID associated with diverse brain areas and cognitive functions. They are also providing an understanding of the potential metacognitive origins of amnesia. Phase-oriented empirically-guided treatments are emerging for DID. CONCLUSIONS The empirical literature on DID is accumulating, although some areas remain under-investigated. Existing data show DID as a complex, valid and not uncommon disorder, associated with developmental and cultural variables, that is amenable to psychotherapeutic intervention.
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Affiliation(s)
- Martin J Dorahy
- 1Department of Psychology, University of Canterbury, Christchurch, New Zealand
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Barlow MR, Chu JA. Measuring fragmentation in dissociative identity disorder: the integration measure and relationship to switching and time in therapy. Eur J Psychotraumatol 2014; 5:22250. [PMID: 24396569 PMCID: PMC3880957 DOI: 10.3402/ejpt.v5.22250] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/16/2013] [Revised: 10/20/2013] [Accepted: 11/20/2013] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND Some people with dissociative identity disorder (DID) have very little communication or awareness among the parts of their identity, while others experience a great deal of cooperation among alternate identities. Previous research on this topic has been sparse. Currently, there is no empirical measure of integration versus fragmentation in a person with DID. In this study, we report the development of such a measure. OBJECTIVE The goal of this study was to pilot the integration measure (IM) and to address its psychometric properties and relationships to other measures. The IM is the first standardized measure of integration in DID. METHOD Eleven women with DID participated in an experiment that included a variety of tasks. They filled out questionnaires about trauma and dissociation as well as the IM. They also provided verbal results about switching among alternate identities during the study sessions. RESULTS Participants switched among identities an average of 5.8 times during the first session, and switching was highly correlated with trauma. Integration was related to switching, though this relationship may be non-linear. Integration was not related to time in psychotherapy. CONCLUSIONS The IM provides a useful beginning to quantify and study integration and fragmentation in DID. Directions for future research are also discussed, including expanding the IM from this pilot. The IM may be useful in treatment settings to assess progress or change over time.
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Affiliation(s)
- M Rose Barlow
- Psychology Department, Boise State University, Boise, ID, USA
| | - James A Chu
- McLean Hospital, Belmont, MA, USA ; Harvard Medical School, Department of Psychiatry, Boston, MA, USA
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Simulation of multiple personalities: a review of research comparing diagnosed and simulated dissociative identity disorder. Clin Psychol Rev 2013; 34:14-28. [PMID: 24291657 DOI: 10.1016/j.cpr.2013.10.008] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2013] [Revised: 10/28/2013] [Accepted: 10/30/2013] [Indexed: 12/25/2022]
Abstract
Dissociative Identity Disorder (DID) has long been surrounded by controversy due to disagreement about its etiology and the validity of its associated phenomena. Researchers have conducted studies comparing people diagnosed with DID and people simulating DID in order to better understand the disorder. The current research presents a systematic review of this DID simulation research. The literature consists of 20 studies and contains several replicated findings. Replicated differences between the groups include symptom presentation, identity presentation, and cognitive processing deficits. Replicated similarities between the groups include interidentity transfer of information as shown by measures of recall, recognition, and priming. Despite some consistent findings, this research literature is hindered by methodological flaws that reduce experimental validity.
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Abstract
The purpose of this study was to assess the scientific and etiological status of dissociative identity disorder (DID) by examining cases published from 2000 to 2010. In terms of scientific status, DID is a small but ongoing field of study. The review yielded 21 case studies and 80 empirical studies, presenting data on 1171 new cases of DID. A mean of 9 articles, each containing a mean of 17 new cases of DID, emerged each year. In terms of etiological status, many of the central criticisms of the disorder's validity remain unaddressed. Most cases of DID emerged from a small number of countries and clinicians. In addition, documented cases occurring outside treatment were almost nonexistent. Finally, people simulating DID in the laboratory were mostly indistinguishable from individuals with DID. Overall, DID is still a topic of study, but the research lacks the productivity and focus needed to resolve ongoing controversies surrounding the disorder.
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Inter-identity autobiographical amnesia in patients with dissociative identity disorder. PLoS One 2012; 7:e40580. [PMID: 22815769 PMCID: PMC3399886 DOI: 10.1371/journal.pone.0040580] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2012] [Accepted: 06/11/2012] [Indexed: 12/05/2022] Open
Abstract
Background A major symptom of Dissociative Identity Disorder (DID; formerly Multiple Personality Disorder) is dissociative amnesia, the inability to recall important personal information. Only two case studies have directly addressed autobiographical memory in DID. Both provided evidence suggestive of dissociative amnesia. The aim of the current study was to objectively assess transfer of autobiographical information between identities in a larger sample of DID patients. Methods Using a concealed information task, we assessed recognition of autobiographical details in an amnesic identity. Eleven DID patients, 27 normal controls, and 23 controls simulating DID participated. Controls and simulators were matched to patients on age, education level, and type of autobiographical memory tested. Findings Although patients subjectively reported amnesia for the autobiographical details included in the task, the results indicated transfer of information between identities. Conclusion The results call for a revision of the DID definition. The amnesia criterion should be modified to emphasize its subjective nature.
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17
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Reinders AATS, Reinders AATS, Willemsen ATM, Vos HPJ, den Boer JA, Nijenhuis ERS. Fact or factitious? A psychobiological study of authentic and simulated dissociative identity states. PLoS One 2012; 7:e39279. [PMID: 22768068 PMCID: PMC3387157 DOI: 10.1371/journal.pone.0039279] [Citation(s) in RCA: 50] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2012] [Accepted: 05/16/2012] [Indexed: 12/03/2022] Open
Abstract
BACKGROUND Dissociative identity disorder (DID) is a disputed psychiatric disorder. Research findings and clinical observations suggest that DID involves an authentic mental disorder related to factors such as traumatization and disrupted attachment. A competing view indicates that DID is due to fantasy proneness, suggestibility, suggestion, and role-playing. Here we examine whether dissociative identity state-dependent psychobiological features in DID can be induced in high or low fantasy prone individuals by instructed and motivated role-playing, and suggestion. METHODOLOGY/PRINCIPAL FINDINGS DID patients, high fantasy prone and low fantasy prone controls were studied in two different types of identity states (neutral and trauma-related) in an autobiographical memory script-driven (neutral or trauma-related) imagery paradigm. The controls were instructed to enact the two DID identity states. Twenty-nine subjects participated in the study: 11 patients with DID, 10 high fantasy prone DID simulating controls, and 8 low fantasy prone DID simulating controls. Autonomic and subjective reactions were obtained. Differences in psychophysiological and neural activation patterns were found between the DID patients and both high and low fantasy prone controls. That is, the identity states in DID were not convincingly enacted by DID simulating controls. Thus, important differences regarding regional cerebral bloodflow and psychophysiological responses for different types of identity states in patients with DID were upheld after controlling for DID simulation. CONCLUSIONS/SIGNIFICANCE The findings are at odds with the idea that differences among different types of dissociative identity states in DID can be explained by high fantasy proneness, motivated role-enactment, and suggestion. They indicate that DID does not have a sociocultural (e.g., iatrogenic) origin.
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Affiliation(s)
- A A T S Reinders
- King's College London, Institute of Psychiatry, Department of Psychosis Studies, London, United Kingdom.
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18
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Abstract
Although intrusive imagery is a common response in the aftermath of a stressful or traumatic event, only a minority of trauma victims show persistent re-experiencing and related psychopathology. Individual differences in pre-trauma executive control possibly play a critical role. Therefore, this study investigated whether a relatively poor pre-stressor ability to resist proactive interference in working memory might increase risk for experiencing undesirable intrusive memories after being exposed to a stressful event. Non-clinical participants (N = 85) completed a modified version of a widely used test of interference control in working memory (CVLT; Kramer and Delis 1991) and subsequently watched an emotional film fragment. Following presentation of the fragment, intrusive memories were recorded in a 1-week diary and at a follow up session 7 days later. A relatively poor ability to resist proactive interference was related to a relatively high frequency of film-related intrusive memories. This relationship was independent of neuroticism and gender. These findings are consistent with the idea that a pre-morbid deficit in the ability to resist proactive interference reflects a vulnerability factor for experiencing intrusive memories after trauma exposure.
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Abstract
Dissociative identity disorder (DID) is probably the most disputed of psychiatric diagnoses and of psychological forensic evaluations in the legal arena. The iatrogenic proponents assert that DID phenomena originate from psychotherapeutic treatment while traumagenic proponents state that DID develops after severe and chronic childhood trauma. In addition, DID that is simulated with malingering intentions, but not stimulated by psychotherapeutic treatment, may be called pseudogenic. With DID gaining more interest among the general public it can be expected that the number of pseudogenic cases will grow and the need to distinguish between traumagenic, iatrogenic or pseudogenic DID will increase accordingly. This paper discusses whether brain imaging studies can inform the judiciary and/or distinguish the etiology of DID.
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Affiliation(s)
- A A T Simone Reinders
- King's College London, Institute of Psychiatry, Division of Psychological Medicine, London, UK.
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Huntjens RJC, Peters ML, Woertman L, van der Hart O, Postma A. Memory transfer for emotionally valenced words between identities in dissociative identity disorder. Behav Res Ther 2007; 45:775-89. [PMID: 16928360 DOI: 10.1016/j.brat.2006.07.001] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2005] [Revised: 06/22/2006] [Accepted: 07/03/2006] [Indexed: 10/24/2022]
Abstract
The present study aimed to determine interidentity retrieval of emotionally valenced words in dissociative identity disorder (DID). Twenty-two DID patients participated together with 25 normal controls and 25 controls instructed to simulate DID. Two wordlists A and B were constructed including neutral, positive and negative material. List A was shown to one identity, while list B was shown to another identity claiming total amnesia for the words learned by the first identity. The identity claiming amnesia was tested for intrusions from list A words into the recall of words from list B and recognition of the words learned by both identities. Test results indicated no evidence of total interidentity amnesia for emotionally valenced material in DID. It is argued that dissociative amnesia in DID may more adequately be described as a disturbance in meta-memory functioning instead of an actual retrieval inability.
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Affiliation(s)
- Rafaële J C Huntjens
- University of Groningen, Department of Developmental and Clinical Psychology, Groningen, The Netherlands.
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Vermetten E, Schmahl C, Lindner S, Loewenstein RJ, Bremner JD. Hippocampal and amygdalar volumes in dissociative identity disorder. Am J Psychiatry 2006. [PMID: 16585437 DOI: 10.1176/appi.ajp.163.4.630] [Citation(s) in RCA: 39] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
OBJECTIVE Smaller hippocampal volume has been reported in several stress-related psychiatric disorders, including posttraumatic stress disorder (PTSD), borderline personality disorder with early abuse, and depression with early abuse. Patients with borderline personality disorder and early abuse have also been found to have smaller amygdalar volume. The authors examined hippocampal and amygdalar volumes in patients with dissociative identity disorder, a disorder that has been associated with a history of severe childhood trauma. METHOD The authors used magnetic resonance imaging to measure the volumes of the hippocampus and amygdala in 15 female patients with dissociative identity disorder and 23 female subjects without dissociative identity disorder or any other psychiatric disorder. The volumetric measurements for the two groups were compared. RESULTS Hippocampal volume was 19.2% smaller and amygdalar volume was 31.6% smaller in the patients with dissociative identity disorder, compared to the healthy subjects. The ratio of hippocampal volume to amygdalar volume was significantly different between groups. CONCLUSIONS The findings are consistent with the presence of smaller hippocampal and amygdalar volumes in patients with dissociative identity disorder, compared with healthy subjects.
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Affiliation(s)
- Eric Vermetten
- Department of Psychiatry, Rudolf Magnus Institute of Neurosciences, University Medical Center, Int mailbox B01206, Heidelberglaan 100, 3584 CX Utrecht, The Netherlands.
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Vermetten E, Schmahl C, Lindner S, Loewenstein RJ, Bremner JD. Hippocampal and amygdalar volumes in dissociative identity disorder. Am J Psychiatry 2006; 163:630-6. [PMID: 16585437 PMCID: PMC3233754 DOI: 10.1176/ajp.2006.163.4.630] [Citation(s) in RCA: 116] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
OBJECTIVE Smaller hippocampal volume has been reported in several stress-related psychiatric disorders, including posttraumatic stress disorder (PTSD), borderline personality disorder with early abuse, and depression with early abuse. Patients with borderline personality disorder and early abuse have also been found to have smaller amygdalar volume. The authors examined hippocampal and amygdalar volumes in patients with dissociative identity disorder, a disorder that has been associated with a history of severe childhood trauma. METHOD The authors used magnetic resonance imaging to measure the volumes of the hippocampus and amygdala in 15 female patients with dissociative identity disorder and 23 female subjects without dissociative identity disorder or any other psychiatric disorder. The volumetric measurements for the two groups were compared. RESULTS Hippocampal volume was 19.2% smaller and amygdalar volume was 31.6% smaller in the patients with dissociative identity disorder, compared to the healthy subjects. The ratio of hippocampal volume to amygdalar volume was significantly different between groups. CONCLUSIONS The findings are consistent with the presence of smaller hippocampal and amygdalar volumes in patients with dissociative identity disorder, compared with healthy subjects.
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Affiliation(s)
- Eric Vermetten
- Department of Psychiatry, Rudolf Magnus Institute of Neurosciences, University Medical Center, Int mailbox B01206, Heidelberglaan 100, 3584 CX Utrecht, The Netherlands.
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Frankel AS, Dalenberg C. The forensic evaluation of dissociation and persons diagnosed with dissociative identity disorder: searching for convergence. Psychiatr Clin North Am 2006; 29:169-84, x. [PMID: 16530592 DOI: 10.1016/j.psc.2005.10.002] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Affiliation(s)
- A Steven Frankel
- Golden Gate University School of Law, 3527 Mt. Diablo Boulevard, Lafayette, CA 94549, USA.
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Pope HG, Barry S, Bodkin A, Hudson JI. Tracking scientific interest in the dissociative disorders: a study of scientific publication output 1984-2003. PSYCHOTHERAPY AND PSYCHOSOMATICS 2006; 75:19-24. [PMID: 16361871 DOI: 10.1159/000089223] [Citation(s) in RCA: 28] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
OBJECTIVE We attempted to track scientific interest in dissociative amnesia and dissociative identity disorder by estimating the annual output of publications regarding these entities over the last 20 years. METHODS Using a standard medical index, PsycINFO, we counted the number of indexed publications involving dissociative amnesia and dissociative identity disorder listed for each year. We then compared these rates with those of well-established diagnoses such as anorexia nervosa, alcohol abuse, and schizophrenia. We also systematically reviewed all publications involving dissociative amnesia that appeared in 2003. RESULTS Annual publications involving dissociative amnesia and dissociative identity disorder rose from low levels in the 1980's to a sharp peak in the mid 1990's, followed by an equally sharp decline to only about one quarter of their peak levels by 2002 and 2003. In contrast, all of the 25 comparison diagnoses in our survey showed constant or steadily rising publication rates; none showed the 'bubble' pattern of the dissociative disorders. Of the 34 papers involving dissociative amnesia identified by PsycINFO for 2003, 10 (32%) appeared skeptical of the validity of dissociative amnesia and/or recovered-memory therapy. Despite a detailed search using multiple medical indices and search terms, we could find only 13 explicit cases of individuals with dissociative amnesia worldwide in the 2003 literature. CONCLUSIONS Dissociative amnesia and dissociative identity disorder have not generated consistent scientific interest over the years, but instead apparently enjoyed a brief period of fashion that now has waned. Overall, our observations suggest that these diagnostic entities presently do not command widespread scientific acceptance.
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Affiliation(s)
- Harrison G Pope
- Biological Psychiatry Laboratory, McLean Hospital, and Department of Psychiatry, Harvard Medical School, Belmont, MA 02478, USA.
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Huntjens RJC, Postma A, Woertman L, van der Hart O, Peters ML. Procedural memory in dissociative identity disorder: When can inter-identity amnesia be truly established? Conscious Cogn 2005; 14:377-89. [PMID: 15950888 DOI: 10.1016/j.concog.2004.10.001] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2003] [Revised: 01/21/2004] [Accepted: 10/04/2004] [Indexed: 10/26/2022]
Abstract
In a serial reaction time task, procedural memory was examined in Dissociative Identity Disorder (DID). Thirty-one DID patients were tested for inter-identity transfer of procedural learning and their memory performance was compared with 25 normal controls and 25 controls instructed to simulate DID. Results of patients seemed to indicate a pattern of inter-identity amnesia. Simulators, however, were able to mimic a pattern of inter-identity amnesia, rendering the results of patients impossible to interpret as either a pattern of amnesia or a pattern of simulation. It is argued that studies not including DID-simulators or simulation-free memory tasks, should not be taken as evidence for (or against) amnesia in DID.
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Affiliation(s)
- Rafaële J C Huntjens
- Department of Clinical Psychology, Research Institute for Psychology and Health, Faculty of Social Sciences, Utrecht University, P.O. Box 80.140, 3508 TC, Utrecht, The Netherlands.
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Huntjens RJC, Peters ML, Postma A, Woertman L, Effting M, van der Hart O. Transfer of newly acquired stimulus valence between identities in dissociative identity disorder (DID). Behav Res Ther 2005; 43:243-55. [PMID: 15629753 DOI: 10.1016/j.brat.2004.01.007] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2003] [Revised: 12/22/2003] [Accepted: 01/20/2004] [Indexed: 11/15/2022]
Abstract
Patients with Dissociative Identity Disorder (DID) frequently report episodes of interidentity amnesia, that is amnesia for events experienced by other identities. The goal of the present experiment was to test the implicit transfer of trauma-related information between identities in DID. We hypothesized that whereas declarative information may transfer from one identity to another, the emotional connotation of the memory may be dissociated, especially in the case of negative, trauma-related emotional valence. An evaluative conditioning procedure was combined with an affective priming procedure, both performed by different identities. In the evaluative conditioning procedure, previously neutral stimuli come to refer to a negative or positive connotation. The affective priming procedure was used to test the transfer of this acquired valence to an identity reporting interidentity amnesia. Results indicated activation of stimulus valence in the affective priming task, that is transfer of emotional material between identities.
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Affiliation(s)
- Rafaële J C Huntjens
- Department of Clinical Psychology, Faculty of Social Sciences, Utrecht University, P.O. Box 80.140, Utrecht 3508 TC, The Netherlands.
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McLeod HJ, Byrne MK, Aitken R. Automatism and dissociation: disturbances of consciousness and volition from a psychological perspective. INTERNATIONAL JOURNAL OF LAW AND PSYCHIATRY 2004; 27:471-487. [PMID: 15337364 DOI: 10.1016/j.ijlp.2004.06.007] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/24/2023]
Affiliation(s)
- Hamish J McLeod
- Department of Psychology, University of Wollongong, Northfields Avenue, NSW 2522, Australia.
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Dorahy MJ, Irwin HJ, Middleton W. Assessing markers of working memory function in dissociative identity disorder using neutral stimuli: a comparison with clinical and general population samples. Aust N Z J Psychiatry 2004; 38:47-55. [PMID: 14731194 DOI: 10.1177/000486740403800101] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
OBJECTIVES Memory functioning is a central conceptual and phenomenological aspect of dissociative identity disorder (DID). Most empirical work on memory functions in DID has focused on retrieval deficits either within or between dissociated identities. The current study attempted to remedy the scant attention given to working memory functioning. METHOD In samples representing the DID, non-clinical, depressed, posttraumatic stress disorder (PTSD) and psychosis populations (n = 10 per group), neutral stimuli were used to examine three markers of working memory functioning: one measuring inhibition; one assessing facilitation; and one measuring interference. RESULTS With the exception of the psychosis sample all groups displayed significant negative priming in the distractor inhibition condition. Facilitation effects were demonstrated by the DID and PTSD groups only. Interference effects were evident in all samples, though the DID and non-clinical groups demonstrated significantly more interference than the psychosis cohort. Distractor inhibition was related to overall schizotypy scores, and dissociation was related to scores in the facilitation condition. CONCLUSIONS The DID sample displayed a completely distinct functional working memory profile to the psychosis sample when assessed with emotionally neutral stimuli. However, the working memory profile in the DID sample was not entirely dissimilar to the other comparison groups.
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Affiliation(s)
- Martin J Dorahy
- Psychologist, Clinical Psychology Program, School of Psychology, Queens University, David Keir Building, Malone Road, Belfast, BT9 5BP, Northern Ireland.
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