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PubMed2005

SCL-90 symptom patterns: indicators of dissociative disorders.

The purpose of this study was to examine the SCL-90 profiles of adult outpatients with and without dissociative disorders. A total of 194 participants were administered the Structured Clinical Interview for DSM-IV Dissociative Disorders-Revised (SCID-D-R) and the Symptom Checklist-90 (SCL-90). Patients with dissociative identity disorder (DID) reported significantly higher SCL-90 Global Severity Index (GSI) and individual subscale scores than those without dissociative disorders. It is recommended that patients who are polysymptomatic on the SCL-90 be considered for follow-up dissociative symptom assessment to aid differential diagnosis and to inform subsequent treatment.

Adolescent↗
PubMed1995

Dissociation and vulnerability to psychotic experience. The Dissociative Experiences Scale and the MMPI-2.

Prior research on the MMPI has cautioned against misdiagnosing schizophrenia in patients with dissociative identity disorder. The present study examined the full spectrum of the dissociative experience in relation to MMPI-2 profiles. Ninety-eight women in treatment for trauma-related disorders completed the Dissociative Experiences Scale and the MMPI-2 in routine inpatient diagnostic evaluations. Consistent with prior research, severe dissociation was associated with high elevations on MMPI-2 scales typically associated with psychotic symptoms. Contrary to hypotheses, the ostensibly most benign form of dissociation, absorption and imaginative involvement, was somewhat more strongly related to MMPI-2 scores than the more pathognomonic forms of dissociation, depersonalization and amnesia. Although it should not be misdiagnosed, severe impairment on the MMPI in conjunction with dissociation should be taken seriously as suggesting vulnerability to psychotic experience. The dissociative retreat from the stressors of outer reality opens the door to the inner world of traumatic images and affects, along with compromised reality testing and disorganized thinking.

Adult↗
PubMed2006

The multidimensional inventory of dissociation (MID): A comprehensive measure of pathological dissociation.

This article describes the development and validation of the Multidimensional Inventory of Dissociation (MID). The MID is a 218-item, self-administered, multiscale instrument that comprehensively assesses the phenomenological domain of pathological dissociation and diagnoses the dissociative disorders. The MID measures 14 major facets of pathological dissociation; it has 23 dissociation diagnostic scales that simultaneously operationalize (1) the subjective/ phenomenological domain of pathological dissociation and (2) the hypothesized dissociative symptoms of dissociative identity disorder (Dell, 2001a). The MID was designed for clinical research and for diagnostic assessment of patients who present with a mixture of dissociative, posttraumatic, and borderline symptoms. The MID demonstrated internal reliability, temporal stability, convergent validity, discriminant validity, and construct validity. The MID also exhibited incremental validity over the Dissociative Experiences Scale (DES) by predicting an additional 18% of the variance in weighted abuse scores on the Traumatic Experiences Questionnaire (TEQ). Confirmatory factor analysis (CFA) did not support a one-factor model of the MID's clinical scales (i.e., the 14 facets and the 23 diagnostic symptoms). In contrast, however, CFA of the MID's factor scales (Dell & Lawson, 2005) has strongly supported a one-factor model. It was concluded that both the MID's 168 dissociation items and the construct of pathological dissociation have a second-order, unifactorial structure.

Adult↗
PubMed2001

The responses of dissociative patients on the thematic apperception test.

This study compared the responses of dissociative inpatients and general inpatient psychiatric controls on the Thematic Apperception Test (TAT; Murray, 1943). We found the stories of dissociative participants to be characterized by a greater interpersonal distance and more trauma and dissociation responses than those of the controls. No significant differences were found regarding total number of emotional references, although references to positive emotions were almost nonexistent for the dissociative group. A post hoc analysis of the data found the testing behaviors of dissociative participants to be characterized by switching, trance states, intrainterview amnesias, and affectively loaded card rejections. Questions were raised regarding the relevancy of the findings to clinical practice and how they might explain some of the controversies surrounding the diagnosis of dissociative identity disorder (DID).

Adult↗
PubMed1995

Psychometric properties of the Dissociative Experiences Scale.

The test-retest reliability of the Dissociative Experiences Scale (DES; Bernstein EM, Putnam FW [1986] Development, reliability, and validity of a dissociation scale. The Journal of Nervous and Mental Disease 174:727-735) in a clinical sample was found to be .93 for the total DES score and .95, .89, and .82 for the three subscale scores of amnesia, depersonalization-derealization, and absorption (dissociative identity disorder [DID], DSM-IV), respectively. Test-retest reliabilities within diagnostic groups of multiple personality disorder, dissociative disorder not otherwise specified, and a general other category of psychiatric diagnoses were obtained for total and subscale scores on the DES. These ranged from .78 to .96. Tests of mean scores across the two test sessions showed the total and subscale scores to be temporally stable. The DES was also found to be highly internally consistent: Cronbach's alphas of .96 and .97 were observed for the total DES scores taken at times 1 and 2, respectively. Construct validity of the DES was demonstrated by differentiation among the subscale scores in a repeated-measures analysis of variance (F[2,154] = 32.03, p < or = .001). Normality and general distribution issues were also addressed and provided a rationale for using the DES with parametric statistics. Reasons why the DES (as it was originally designed) is not appropriate as a dependent measure in outcome research are discussed, along with needed future research. Implications of the findings for the clinical usefulness of the DES as a diagnostic instrument are noted.

Adult↗
PubMed1997

Dissociation as complex adaptation.

In this article the general theory of complex adaptive systems, substantiated by non-linear dynamics, will be used to put the dissociative disorders into a theoretical framework and clarify their genesis and presentation. When a system is far out of equilibrium, dissipative structures may be formed ('order out of chaos', as Prigogine (1) has put it). These structures provide the starting point for further evolution and co-evolution of competing groups of functional schemata divided on a bifurcation surface. Complex adaptation is almost inevitable in a complicated system (such as the brain) driven by non-linear dynamics. Dissociation is thus regarded as a consequence of adaptation to a chaotic environment rich in contrasts. In a sufficiently complex environment a person with dissociative identity disorder is more adapted and thus more likely to occur than a 'normal' monopersonality individual.

Adaptation, Psychological↗
PubMed2005

The validity of DSM-IV dissociative disorders categories in south-west Uganda.

There is little systematic research on the cross-cultural validity of the dissociative disorders, especially in non-western countries. This study evaluates the fit of the DSM-IV classification and concepts of these disorders with local concepts, experiences and local presentations in south-west Uganda. We conducted focus group discussions with medical students, traditional healers, religious leaders, counselors, community members and other health workers (n=48). They were supplemented by key informant interviews with religious people, traditional healers and leaders (n=11). The responses were subjected to thematic analysis. Dissociative amnesia and depersonalization were generally recognized and seen as the result of traumatic experiences and were useful categories in Uganda. However, dissociative fugue did not match local concepts and was confused with spirit possession and other conditions such as alcoholic fugues and dementia. The description of dissociative identity disorder was always interpreted as a possession trance disorder by the local healers. We found only partial support for the validity of the DSM-IV classification of dissociative disorders in Uganda.

Adult↗
PubMed2003

Perceptually oriented hypnosis.

This theoretical article explores postulates representative of a perceptual frame of reference for a better understanding of hypnotic experiencing. This author contends that Perceptual Psychology, a theory first conceptualized by Snygg and Combs, as revised by Combs, Richards, and Richards in 1988, and Perceptually Oriented Hypnosis provide an effective way of understanding hypnosis, the therapist-client relationship, and has some implications as well for better comprehending psychopathology. Perceptually oriented hypnotic principles are shown to enhance the characeristics of the adequate personality, expand the phenomenal field, change personal meanings, and change aspects of the phenomenal self in the context of hypnosis. Implications for understanding differing views and conflicting perceptions of reality held by scientists and researchers are discussed. Implications for Dissociative Identity Disorder are also addressed. Research utilizing Giorgi's research methodology and Wasicsko's qualitative procedure for assessing educators' dispositions is suggested.

Culture↗
PubMed1981

Multiple personality and related dissociative phenomena in patients with temporal lobe epilepsy.

Many patients with temporal lobe epilepsy also experience dissociative episodes. Three patients with multiple personality exhibited alterations in speech pattern, personality, handedness, and sense of personal identity and claimed amnesia for the dissociative episodes. Another 10 patients identified alternative personalities or demons as motivators of ego-alien behavior. Of clinic patients with temporal lobe epilepsy, 33% exhibited some dissociative phenomena, which had no apparent association with individual seizures but always followed the development of the seizure disorder. The authors propose that intensified, dystonic affects, characteristic of the interictal period in temporal lobe epilepsy, may predispose some individuals to dissociative reactions.

Adult↗
PubMed2005

Development of the Hebrew-Multidimensional Inventory of Dissociation (H-MID): a valid and reliable measure of pathological dissociation.

The Multidimensional Inventory of Dissociation (MID; Dell, 2004b) has 168 dissociation items and 50 validity items. The MID assesses 14 major facets of dissociation, 23 symptoms of dissociation, and has 5 validity scales. The MID operationalizes (a) the subjective/ phenomenological domain of dissociation, and (b) 23 hypothesized symptoms of dissociative identity disorder (DID). This article describes the development of a Hebrew version of the MID (H-MID). In a sample of clinical and nonclinical research participants, the H-MID had strong internal consistency, temporal stability, and strong structural, convergent, discriminant, and construct validity. In addition, mean H-MID scores demonstrated incremental validity over the Hebrew Dissociative Experiences Scale (H-DES) by predicting an additional 17% of the variance in weighted trauma scores on the Traumatic Experiences Questionnaire (TEQ). Factor analysis of the H-MID extracted a single factor: dissociation. Both the MID and the subjective/phenomenological concept of pathological dissociation appear to have applicability not only in North America, but also in a heterogeneous Middle Eastern culture.

Adult↗
PubMed1996

Dissociation: the clinical realities.

An attempt was made by the authors of DSM-III to restrict its focus to the experimental, the observable, and the measurable. The intention was to free the nosology from the influence of unproven theories, and the philosophy was driven largely by the importance of research being able to identify diagnostic categories to facilitate the study of homogeneous groups. So it is of interest that the authors accepted dissociation-an ambiguous event linked to an explicit theoretical concept that had been introduced by Janet-as the basis for classification of clinical presentations that were formerly included under the rubric of hysteria, a similarly unclear category. Since DSM-III, there have been an increasing number of reports of dissociative experiences and dissociative identity disorder (formerly known as multiple personality disorder), but neither of these clinical presentations seems able to withstand the concern that it is dramatically influenced by environmental cues, e.g., the expectations of the therapist. Thus, a restricted phenomenological perspective does not fully appreciate the distorting potential of suggestibility and imagination on the nature of the emerging clinical picture. These factors might well have contributed to and laid the conceptual groundwork for the growth in the number of reports of dissociation.

Adult↗
PubMed1981

Multiple personality in India: comparison with hysterical possession state.

This article reports probably the first case of multiple personality from India and compares and contrasts it with the hysterical possession syndrome. Attention is drawn to the apparent rarity of multiple personality in contrast to the great prevalence of the possession syndrome in India (and other underdeveloped societies), while the reverse applies to Western Europe and North America. It is postulated that the disparity of frequency between the two manifestations of personal-identity disturbance derives from certain basic cultural differences. It is argued that polytheism and belief in reincarnation and spirits may be related to the possession syndrome, whereas high social approval of deliberate role-playing may foster the multiple personality syndrome.

Adult↗
PubMed1997

'Free to be' peer group supports patients with MPD/DD.

1. During the last decade, dissociative identity disorder increasingly has been recognized as a relatively common post-traumatic syndrome. 2. Individuals with MPD/DD often are estranged from abusive families and have difficulty with social connection; an urgent therapeutic task is the re-creation of a sense of human interdependency and community. 3. Group therapy can be a useful and successful adjunct to individual psychotherapy for relatively stable clients with MPD/DD; the group's focus should be here-and-now, supportive, and psychoeducative in nature.

Dissociative Disorders↗
PubMed1991

Embodied alternative identities. Bearing witness to a world that might have been.

In all cultures, embodied alternative identities provoke powerful reactions among those who observe and interact with them. Although these entities are invariably understood to reflect intense subjective experiences, they represent much more than a public expression of a pathologic mental disorder. They form an integral part of the meaningful, highly complex, symbolic systems that both inform and reflect the local cultures in which they emerge. Consequently, an understanding of just how these entities learn to understand themselves may be the cross-cultural key to an understanding of just what they are.

Anthropology, Cultural↗
PubMed2003

Directed forgetting between, but not within, dissociative personality states.

To investigate amnesia between identities in dissociative identity disorder (DID), the authors assessed explicit and implicit memory performance on a directed-forgetting task in 12 DID patients who switched from one state to an "amnesic" state between presentation and memory testing. DID patients were instructed either to remember or to forget neutral and emotional words. Besides an overall decrease in explicit memory, patients demonstrated selective forgetting of to-be-forgotten, but not of to-be-remembered words in the amnesic state. Patients did not exhibit any directed forgetting within the same state. Implicit memory was fully preserved across states. Independent of state, patients recalled more emotional than neutral information. These results may extend the conceptualization of memory processes in DID, suggesting an important role for retrieval inhibition.

Adult↗
PubMed2005

Aspects of the unity of consciousness and everyday memory failures.

We argue that analyzing everyday memory failures in terms of the "unity of consciousness" can elucidate the bases of such failures. A perfect unity amongst one's mental states is rare. In extreme cases the unity of consciousness can breakdown in dramatic fashion (e.g., in Dissociative Identity Disorder), but such breakdowns also occur in less dramatic ways that affect us in everyday life. For example, disruptions in the unity of consciousness can result in everyday memory failures, such as forgetting to put on a tie for an important formal meeting. After providing some philosophical background into the notions of "unity of consciousness" and "functionalism," we offer preliminary analyses of three examples of everyday memory failure. We then introduce and develop what we call the "unity model" of memory failure and show how it explains the examples. We also describe different ways that unity can break down which, in turn, can lead to memory failure and inappropriate behavior. We then show how slips of action and other kinds of cognitive failures (e.g., memory blocks) differ from everyday memory failures. Finally, we examine alternative models (e.g., Absentmindedness and Multimodal) arguing that the unity model is preferable, and then show how our model is consistent with some experimental results.

Cognition↗
PubMed2002

Cultural scripts, memories of childhood abuse, and multiple identities: a study of role-played enactments.

This study compared the reports of satanic, sexual, and physical abuse of persons instructed to role-play either dissociative identity disorder (DID) (n = 33), major depression (n = 33), or a college student who experienced minor adjustment problems ("normal") (n = 33) across a number of trials that included role-played hypnosis. As hypothesized, more of the participants who were asked to role-play DID reported at least one instance of satanic ritual abuse and sexual abuse compared with those who role-played depression or a college student with minor adjustment problems. DID role-players reported more incidents of sexual abuse and more severe physical and sexual abuse than did the major depression role-players. Further, the DID role-players differed from the normal role-players on all the measures of frequency and severity of physical and sexual abuse. Participants in all groups reported more frequent and severe incidents of physical abuse after role-played hypnosis than they did prior to it.

Adjustment Disorders↗