PubMed Health⌕ Search

SEARCH · PubMed Health

Results for “Dissociative Identity Disorder”

Explore indexed PubMed citations for clinical trials, systematic reviews and public health research. Read source abstracts and follow each citation to its original PubMed record.

Quote a phrase for an exact phrase match. Source license links do not imply unrestricted reuse.

At least 325 records · Page 18Linked to original sources
PubMed1995

Vicarious traumatization in the work with survivors of childhood trauma.

1. Persons working with victims of childhood trauma may experience traumatic countertransference and vicarious traumatization. After hearing a patient's trauma story, which is a necessary part of childhood trauma therapy, staff may experience post-traumatic stress disorder, imagery associated with the patient's story and the same disruptions in relationships as the patient. 2. During the first 6 months of working with survivors of childhood trauma, common behaviors of staff members were identified, including a lack of attention, poor work performance, medication errors, sick calls, treatment errors, irreverence, hypervigilance, and somatic complaints. 3. Staff working with victims of childhood trauma can obtain the necessary staff support through team support, in traumatic events, and in a leadership role.

Adaptation, Psychological↗
PubMed1995

Coping strategies: a psychoeducational approach to post-traumatic symptomatology.

Survivors of extensive childhood abuse frequently present complicated clinical dilemmas in the inpatient setting; they experience complex post-traumatic and dissociative symptomatology, such as flashbacks and other reexperiencing phenomena, as well as intense affects and self-destructive impulses. Such patients seek recommendations of how to manage their post-traumatic symptomatology, as well as how to tolerate intense affects and maintain safety. The nursing staff at McLean Hospital's Dissociative Disorders Program have developed a psychoeducational approach that patients have found useful. Coping strategies, which the patients learn to formulate, help clients stall impulsivity and dissociative episodes through the use of healthy diversions, grounding techniques, and support networks.

Adaptation, Psychological↗
PubMed2000

[Dissociative disorders: from Janet to DSM-IV].

I reviewed the literature on dissociation and dissociative disorders from Pierre Janet to DSM-IV, and examined the current trends in research. Janet's theory on hysteria is multifaceted, and is based on three psychological models. Based on a hierarchical model, Janet related hysteric symptoms to the activities within the lower strata of mental hierarchy (automatisms psychologiques), which were demonstrably shown in somnambulism. A second model was based on the concept of a psychological system, which was hypothetically composed of ideas, images, feelings, sensations, and movements. According to this model, dissociation of psychological functions was fundamental to the mechanism of hysteria: loss of integration was thought to engender fixed ideas (ideas fixes) and to lead to the development of a system totally isolated from the whole personality system. Janet also attempted to explain various mental disorders using an economic model. He referred to a loss of equilibration between psychological force and psychological tension. Thus, an unexpected emotional experience was conceived to cause a consumption of reserved psychological force, which was in turn followed by exhaustion associated with hysteric symptoms. Whereas most current researchers regard Janet as the first to study psychological trauma as a principal cause of dissociation, I feel it is important to note that he also emphasized the role of stigmata, i.e., permanent traits of hysteric patients, which were represented as a suggestibility and a tendency toward a narrowing of the consciousness field. Discussion about dissociation and its relation to trauma all but disappeared after Janet. However, during the Second World War and post-war period, some psychiatrists began to pay attention to two emerging phenomena: a high incidence of dissociative symptoms such as fugue and amnesia among combatants, and traumatic neurosis frequently observed among ex-inmates of concentration camps. In the 1970s, interest in dissociation and trauma was revived in different areas: the feminism movement was linked with concerns about child sexual abuse, public curiosity about multiple personalities was heightened by novels and movies, and recognition of posttraumatic stress disorder (PTSD) among Vietnam War veterans. In 1980, dissociative disorders were finally adopted as a diagnostic category in the official nomenclature of DSM-III. Although current research on dissociation is being carried out in various fields, two basic assumptions, reflected in the definition of DSM-IV, can be made. One is the "trauma-genic hypothesis," and the other is the great importance attached to multiple personality disorder (MPD). According to the predominantly held view, dissociation represents a reaction to early traumatic experience, especially sexual and physical abuse in childhood. In contrast, some authors argue that the causality of childhood traumatic experience has not been empirically confirmed, and other factors such as the influence of the environment and the predisposition of patients should be taken into consideration. MPD, which was originally described as an unusual phenomenon in classical literature, is currently thought to be a common type of dissociation. However, the reported rapid increase in the number of MPD patients in North America may be partially due to over-diagnosis and inclusion of iatrogenic cases. Significance is also given to MPD in respect to classification of dissociative phenomena. According to the widely held scheme of a "dissociative continuum," which ranges from normal experiences such as daydreams to pathological states, MPD is placed at the extreme end of the continuum. Furthermore, most researchers tend to classify MPD as the severest dissociative disorder due to chronic trauma. On this point, there seems to be confusion about "extremity" and "severity" of MPD. I conclude that the trauma-genic hypothesis of dissociation and the overemphasis placed on MPD should be reexamin

Adult↗
PubMed1991

Recent research on multiple personality disorder.

The last decade has seen the emergence of solid research on MPD and the dissociative disorders, particularly in the area of diagnosis and clinical phenomenology. A number of other areas have been opened up or advanced considerably. The most notable of these include child and adolescent dissociative disorders; investigation of dissociative memory disturbances; studies of differential alter personality psychophysiology and switching; cross-cultural comparisons of MPD, possession, and dissociative states; and the contribution of pathologic dissociation to the symptomatology of other psychiatric disorders. Yet to be attempted, however, are prospective clinical trials and treatment outcome studies. In addition to clinical and theoretical insights, recent research provides strong evidence for the validity of the diagnosis of MPD. The repeated replication of a core clinical phenomenology demonstrates a construct validity equal to or superior to that demonstrated for most DSM-III/IIIR disorders. The ability of several independently developed instruments to blindly discriminate MPD patients from nondissociative disorder patients with high rates of accuracy supports both the construct and discriminant validity of the diagnosis; and as the astute clinical observations of the last century continue to be confirmed, MPD manifests an historical validity absent in most modern era diagnoses. In the future, arguments about the "reality" of MPD cannot confine themselves merely to attacking one aspect of the disorder but rather must confront the broad range of evidence supporting the validity and reliability of the diagnosis. The future belongs to multicenter studies, although intensive single-case and personal-case series will continue to make important contributions in some areas. The essential elements necessary to begin prospective multicenter studies are rapidly coming together. Already one multicenter structured interview study of clinical phenomenology has been completed and other studies are underway or near publication. As these collaborative research networks mature, even more ambitious studies will be attempted. Adequate funding remains the principal obstacle and must be creatively addressed in this era of budgetary shortfalls, particularly as several research networks cross international boundaries. Exceptionally gratifying is the burgeoning interest of large numbers of psychiatric residents and psychology graduate students in the dissociative disorders. Thanks to a decade of hard work, the next generation of clinicians and researchers will know a great deal more about these patients than the last.

Dissociative Disorders↗
PubMed1991

Epidemiology of multiple personality disorder and dissociation.

A recent survey of a large sample of the general population in the city of Winnipeg, Manitoba, showed that multiple personality disorder related to childhood abuse affects about 1% of the adult population. About 10% of the adult population has had a DSM-III-R dissociative disorder of some kind. Pathologic dissociation appears to be a major form of emotional disturbance in North America, and it appears to be about as common as anxiety, mood, and substance abuse disorders. The dissociative disorders can no longer be considered rare.

Borderline Personality Disorder↗
PubMed1991

Dissociative disorders in children and adolescents. A developmental perspective.

Childhood and adolescent dissociative disorders are being diagnosed increasingly by mental health professionals who work with traumatized children. The identification of these conditions is hampered by the high background level of normal dissociative behavior observed in children and adolescents. An awareness of the underlying developmental processes and issues can aid in the identification of pathologic dissociation.

Adolescent↗
PubMed1991

The psychological organization of multiple personality disordered patients as revealed in psychological testing.

The reader familiar with the borderline literature may see a correspondence between certain of our MPD/DD Rorschach results and typical borderline characteristics. Most notably, both groups reason and view others in unusual but not psychotic ways and demonstrate certain difficulties in affect integration. On the other hand, the MPD/DD group exhibits many attributes that contradict predictions one would make from a borderline perspective, and which support Kluft's assertion that the majority of these patients have a more complex and structured personality system. Rather than holding oversimplified attitudes, they are attuned to the subtleties of experience. Their generally introversive personality style reflects a capacity for internalization, for ideational organization of anxiety, for taking analytic distance from themselves, and for viewing and relating to others in a complex and empathetic fashion. To return to our metaphor of the explorer, we can conclude that the borderline personality concept gives us too broad and blurred a view of the MPD/DD terrain. It lacks the level of specificity needed to describe the test phenomena that appear on these MPD/DD Rorschachs. The special test instructions, behavior ratings of extra-test dissociative phenomena, and the posttest process questions enable us to see that although at gross level certain vulnerabilities resemble borderline characteristics, the processes underlying these phenomena are quite distinct. Moreover, unexpected areas of strength and maturity also exist. These findings suggest that we are not viewing a developmental arrest, but rather, are seeing the signs of what developmental psychologists call a "strange" development i.e., an atypical developmental pathway created by unusual interactions with the world. It may well be that much of the difficulty in establishing the validity of BPD test criteria has been due to the unwitting inclusion of DD patients within these studies. If so, the distinction between borderline and dissociative test characteristics will lead to more accurate and refined studies of both groups. The concept of PTSD has been a particularly useful dimension for elucidating MPD test phenomena. As we further investigate commonalities and differences within the MPD/DD continuum, it will be interesting to examine in what way the severity of these patients' PTSD relates to their personality characteristics, symptom patterns, and treatment response. The strength of psychological assessment has long been its ability to describe the organization of psychological processes to gain a detailed knowledge of the individual. As such, in the hands of well-trained clinicians, psychological assessment has been one of the most powerful tools for predicting long-term treatment outcome.(ABSTRACT TRUNCATED AT 400 WORDS)

Borderline Personality Disorder↗
PubMed1991

The comorbidity of multiple personality disorder and DSM-III-R axis II disorders.

Our ability to differentiate MPD from DSM-III-R Axis I disorders has become increasingly refined. Differentiation of MPD from the Axis II personality disorders is an area of more recent clinical investigation. MPD can be found comorbidity with many other psychiatric conditions. It is found in association with each of the DSM-III-R personality disorders. At the present time, however, we lack research data that define the prevalence of the comorbidity of MPD with the personality disorders. Objective study of this area is complicated by the paucity of instruments available to assess personality dimensions in the presence of a DD. In addition, the currently available personality inventories tend to overdiagnose BPD in patients with a high level of distress and acuity of symptoms. The diagnosis of a personality disorder in a patient with MPD is made on the basis of the assessment of the "whole" human being. It is based on the presence of a pervasive and relatively inflexible pattern of behaviors that reflects the individual predominant mode of being. The diagnosis of a personality disorder is not made on the basis of personality traits contained within any single alternate personality or groups of personalities. The personality disorders defined by DSM-III-R are a heterogeneous group of conditions whose individual etiologies reflect a complex interplay of constitutional, genetic, environmental, interpersonal, and psychodynamic factors. The interplay is variable and diverse between these determinants of the personality disorders and the traumatic forces that result in the development of a DD. For the Cluster A personality disorders (schizoid, schizotypal, paranoid), there is evidence supporting a relationship with specific psychotic illnesses. The combination of dissociative pathology with these personality disorders commonly results in a greater impairment of reality testing than in either condition alone. The Cluster B personality disorders (histrionic, narcissistic, borderline, antisocial) and Cluster C personality disorders (avoidant, compulsive, dependent, passive-aggressive) are believed to be primarily developmental disturbances. Comorbidity of these personality disorders with MPD involves consideration of the interaction of many developmental processes with the psychological impact of severe childhood trauma. Many MPD patients present with an apparent mixed personality profile consisting of an array of avoidant, compulsive, borderline, narcissistic, dependent, and passive-aggressive features. Although this article explores comorbidity of MPD with each of the personality disorders defined in DSM-III-R individually, it seems likely that a number of posttraumatic personality organizations can be defined that commonly coexist with MPD.(ABSTRACT TRUNCATED AT 400 WORDS)

Borderline Personality Disorder↗
PubMed1991

An office mental status examination for complex chronic dissociative symptoms and multiple personality disorder.

Chronic complex dissociative symptoms can be readily inquired about in the diagnostic interview leading to a clinical diagnosis of MPD in many cases. It is most useful to begin with inquiry about amnesia, autohypnotic, posttraumatic, pseudopsychotic, and passive-influence symptoms, and childhood abuse or traumatization. As this proceeds, overt dissociation is commonly noted including spontaneous trances, age-regression, blending or overlap of states, or frank switching. When this occurs, the interviewer can pursue more detailed information about the patient's experiences. Tracking these processes may readily lead to the clear appearance of an alter personality or will help make the patient sufficiently comfortable that he or she will allow the full emergence of an alter if this is directly requested. In other cases, however, methods such as use of ideomotor signals, formal induction of trance, and even barbiturate-facilitated interviews may be necessary to permit the full emergence of an alter. The symptom-cluster method is a useful clinical diagnostic tool to elicit dissociative symptoms for the diagnosis of MPD. Combined with diagnostic tools such as the DES, the DDIS, and the SCID-D, this method can help the clinician make the diagnosis of MPD in a far more expeditious and rigorous fashion. In addition, all psychiatric patients should be screened for a history of blackouts, time loss, trance experiences, childhood trauma, and PTSD symptoms. This will improve case finding to help clinicians begin to treat the single largest preventable cause of mental illness: the sequelae of childhood abuse, trauma, and family violence.

Dissociative Disorders↗
PubMed1991

Clinical presentations of multiple personality disorder.

It is hoped that this discussion of MPD will discourage stereotypic thinking about this condition and encourage the inclusion of MPD in virtually all differential diagnoses. The major thrust of what has been learned about the natural history of MPD is that most patients with this condition spend most of their lives not manifesting their MPD in classic manner. The typical presentation of MPD is the tip of a rather large iceberg. Covert and other nonclassic presentations are much more characteristic. An appreciation of this will help the clinician approach the diagnosis of MPD with a heightened sensitivity to the possibility of encountering it within his or her practice.

Adult↗
PubMed1991

Inpatient treatment of children with multiple personality/dissociative disorders and their families.

A number of children who are admitted for inpatient psychiatric treatment have experienced significant trauma and abuse. It is important to evaluate them for the presence of a DD. The variety, complexity, and subtlety of the symptomatic presentation of childhood MPD makes differential diagnosis difficult, and it is probable that many cases have been missed in the past. Detailed historical information and extensive behavioral observations in a variety of settings can assist in establishing the diagnosis and in delineating areas for therapeutic intervention. Hospitalization may be necessary to conduct an adequate evaluation, develop a therapeutic alliance, safely manage behaviors that are injurious to the child or others, and/or to diffuse potentially volatile family situations. All members of a multidisciplinary inpatient team play important roles in the achievement of successful therapeutic intervention with dissociating children and their families. Skilled family therapy is often an important adjunct to therapeutic interventions focused on the child, particularly when the parent also has MPD. Knowledge of the psychodynamic issues involved in dissociation can be used to develop behavioral interventions that are successful in decreasing the child's need to dissociate, improving his or her overall functioning, and help him or her gain mastery over problematic behaviors.

Adolescent↗
PubMed1991

Psychotherapy and case management for multiple personality disorder. Synthesis for continuity of care.

Patients with MPD are often difficult to manage in the community. These patients have a chaotic lifestyle with acting out behaviors and traumatic relationships. They have difficulty in managing time, maintaining good function, and being safe. The prognosis is good, however, with intensive psychotherapy. Still, containment of the treatment, which is often stormy, is a difficult task. Clinical case management is a treatment modality that strives to bring order out of chaos, stabilize the patient in the community, and encourage the highest level of function during treatment. It is useful to conceptualize case management as a framework for MPD psychotherapy, both to contain the therapy and to be drawn on for strength and resources. The stages of MPD therapy can be intertwined with the core case management functions of assessing, planning, linking to resources, monitoring, and advocacy to facilitate continuity of care for the patient. The synthesis of psychotherapy and case management can decrease chaos for both the patient and therapist, facilitate the patient's function on a daily basis, and increase connectedness for the patient and needed services. There is an art and a subtlety to the synthesis that grows with awareness and experience of the therapist/case manager. It is a synthesis worthy of development and implementation.

Abreaction↗
PubMed1991

Treatment stabilization and crisis prevention. Pacing the therapy of the multiple personality disorder patient.

This article briefly reviews the tactical integrationist's perspective in the work with multiple personality disorder patients. Its foundation is a cognitively based treatment paradigm geared toward controlled abreactions with cognitive restructuring throughout therapy. It is a suppression-dilution-of-affect model that focuses on the achievement of control and mastery for patient and therapist alike.

Adaptation, Psychological↗