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PubMed1998

[Differential diagnosis of dissociative identity disorder (multiple personality disorder)].

Recently the concept of dissociative identity disorder (formerly known as multiple personality disorder) has attracted increasing public and scientific interest. However, it is rarely diagnosed in the clinical setting. the reported case of a 47-year-old woman with a history of child abuse demonstrates the problems of differential diagnosis. A number of psychopathologic symptoms pointed to a multiple personality disorder, but in the follow-up psychotic symptoms such as delusions, possible hallucinations and bizarre behavior clearly emerged. The differential diagnosis of dissociative identity disorder includes paranoid schizophrenia, as in the case described, borderline personality disorder, hysteria, simulation and the false memory syndrome. Finally, social and cultural factors have to be considered.

Child↗
PubMed1994

Dissociative identity disorder: adaptive deception of self and others.

Dissociative identity disorder (multiple personality) is increasingly diagnosed, often follows childhood trauma, and is characterized by rigidification of phenomena that resemble hypnosis. To interpret dissociated aspects of selfhood as autonomous entities is a useful heuristic; but when taken too literally, it leads to three kinds of anomaly: (1) legal: dissociators remain culpable for misdeeds carried out beyond apparent awareness or control; (2) clinical: legitimization sometimes leads not to relief, but to escalating cycles of regressive dependency; and (3) scientific: the form of dissociated entities varies with how they are defined, in ways that are intrinsically motivated and clinically manipulable. These anomalies yield to an evolutionary perspective that views dissociative identity disorder as an evolved strategy of adaptive deception of self and others; e.g., a beaten subordinate avoids further retribution by "pleading illness." Such a deceit best avoids detection when fully experienced; through its intensity and persistence, it becomes real at a new level. One's basic competencies remain intact, however, and are the source of the anomalies described. They can be clinically accessed and empowered, providing the key to therapeutic change when dissociative processes are problematic. Overall, despite clear impairment in subjective awareness and volition, dissociative-disordered individuals are best held fully accountable for the consequences of their actions.

Awareness↗
PubMedDate not supplied

Dissociative identity disorder and substance abuse: the forgotten relationship.

The treatment and research of dissociative disorders, particularly dissociative identity disorder (DID), are hampered by professional skepticism and diagnostic uncertainties. Almost always associated with severe and sustained childhood trauma, its chief manifestations are at least two distinct and separate identities which have an independent manner of existing in the world. It is also associated with a high degree of psychiatric comorbidity. Among the most frequent diagnoses found in patients with DID are substance use and dependence. For a variety of reasons there has been little dialogue among the disciplines that study patients with trauma and those that study and treat substance abuse. Clinicians dealing with a primarily substance-abusing population are likely to encounter but not recognize these patients. The authors present several representative cases illustrative of features of patients with DID. The epidemiology, phenomenology and presentation of DID, as well as its relation to posttraumatic stress disorder are discussed. Little systematic investigation exists on the treatment of DID in general, and substance abuse in DID in particular. The authors draw upon the existing literature, and their experience to discuss treatment strategies aimed at treating patients with both diagnoses. Ignoring either diagnosis is likely to be detrimental to patients; both disorders and their coexistence need to be addressed.

Adult↗
PubMed2006

Psychobiological characteristics of dissociative identity disorder: a symptom provocation study.

BACKGROUND: Dissociative identity disorder (DID) patients function as two or more identities or dissociative identity states (DIS), categorized as 'neutral identity states' (NIS) and 'traumatic identity states' (TIS). NIS inhibit access to traumatic memories thereby enabling daily life functioning. TIS have access and responses to these memories. We tested whether these DIS show different psychobiological reactions to trauma-related memory. METHODS: A symptom provocation paradigm with 11 DID patients was used in a two-by-two factorial design setting. Both NIS and TIS were exposed to a neutral and a trauma-related memory script. Three psychobiological parameters were tested: subjective ratings (emotional and sensori-motor), cardiovascular responses (heart rate, blood pressure, heart rate variability) and regional cerebral blood flow as determined with H(2)(15)O positron emission tomography. RESULTS: Psychobiological differences were found for the different DIS. Subjective and cardiovascular reactions revealed significant main and interactions effects. Regional cerebral blood flow data revealed different neural networks to be associated with different processing of the neutral and trauma-related memory script by NIS and TIS. CONCLUSIONS: Patients with DID encompass at least two different DIS. These identities involve different subjective reactions, cardiovascular responses and cerebral activation patterns to a trauma-related memory script.

Adult↗
PubMedDate not supplied

Comparison of dissociative identity disorder with other diagnostic groups using a structured interview in Turkey.

Twenty patients with dissociative identity disorder (DID), 20 with schizophrenic disorder, 20 with panic disorder, and 20 with complex partial epilepsy were evaluated with the Dissociative Disorders Interview Schedule (DDIS) and the Dissociative Experiences Scale (DES). Subjects with dissociative identity disorder were more frequently diagnosed as having somatization disorder, past or concurrent major depressive episode, borderline personality disorder, depersonalization disorder, and dissociative amnesia than other groups. They reported Schneiderian symptoms and extrasensory perceptions more frequently. In their anamnesis suicide attempts, trance states, sleepwalking, and childhood traumas were more frequent than those in comparison groups. The secondary features of dissociative identity disorder and the DES score differentiated these patients from comparison groups significantly. DID has a set of clinical features different from that of schizophrenic disorder, panic disorder and complex partial epilepsy. The differences are similar to those yielded previously in studies from North America.

Adult↗
PubMed2006

Hippocampal and amygdalar volumes in dissociative identity disorder.

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.

Adult↗
PubMed1998

Axis II pathology in outpatients with dissociative identity disorder.

Forty-two outpatients with dissociative identity disorder (DID) and 16 outpatients with dissociative disorder not otherwise specified (DDNOS) were administered the Millon Clinical Multiaxial Inventory-II (MCMI-II), the Minnesota Multiphasic Personality Inventory-2 (MMPI-2), and the Dissociative Experiences Scale (DES). DID patients manifested severe personality pathology (BR > 84) on a mean of 4.0 MCMI-II scales: avoidant (76%), self-defeating (68%), borderline (53%), and passive-aggressive (45%). DDNOS cases had severe personality pathology on fewer MCMI-II scales (mean = 1.69): avoidant (50%) and self-defeating (31%). The DID and DDNOS groups differed in their scores on the DES (means = 54.9 vs. 25.9), the PK-PTSD scale of the MMPI-2 (means = 33.6 vs. 21.7), and in the incidence of severe borderline pathology (53% vs. 6%). These data on personality pathology in DID patients are virtually identical to those of seven previous studies of personality pathology in chronic PTSD patients (i.e., avoidant, self-defeating, borderline, and passive-aggressive). Such robust convergence of findings supports the construct validity of DID as a form of posttraumatic disorder and suggests that there is a quite predictable personologic core to the clinical picture of severely traumatized individuals.

Adult↗
PubMedDate not supplied

Frequency of dissociative identity disorder in the general population in Turkey.

This study attempted to determine the prevalence of dissociative identity disorder in the general population. The Dissociative Experiences Scale (DES) was administered to 994 subjects in 500 homes who constituted a representative sample of the population of Sivas City, Turkey. The mean DES score was 6.7+/-6.1 (mean +/- SD). Of the 62 respondents who scored above 17 on the DES, 32 (51.6%) could be contacted during the second phase of the study. They were matched for age and gender with a group of respondents who scored below 10 on the scale, and the Dissociative Disorders Interview Schedule (DDIS) was then administered to both groups. Seventeen subjects (1.7%) received a diagnosis of dissociative disorder according to the structured interview. In the third phase, eight of 17 subjects who had a dissociative disorder on the structured interview could be contacted for a clinical evaluation. They were matched with a nondissociative control group and interviewed by a clinician blind to the structured interview diagnosis. Four of eight subjects were diagnosed clinically with dissociative identity disorder, yielding a minimum prevalence of 0.4%. Dissociative identity disorder is not rare in the general population. Self-rating instruments and structured interviews can be used successfully for screening these cases. Our data, derived from a population with no public awareness about dissociative identity disorder and no exposure to systematic psychotherapy, suggest that dissociative identity disorder cannot be considered simply an iatrogenic artifact, a culture-bound syndrome, or a phenomenon induced by media influences.

Adolescent↗
PubMed1995

Positive and negative symptoms in dissociative identity disorder and schizophrenia: a comparative analysis.

A substantial number of patients with dissociative identity disorder have had previous diagnoses of schizophrenia, due to the presence of positive symptoms of schizophrenia. The authors investigated the pattern of positive and negative symptoms in patients with dissociative identity disorder, and compared it with norms in schizophrenia. A total of 108 patients with a clinical diagnosis of dissociative identity disorder were administered the Positive and Negative Syndrome Scale. The positive symptom and general psychopathology scores were significantly more severe in the dissociative identity group than the norms for schizophrenia, while the negative symptoms were significantly more severe in schizophrenia. Since patients with dissociative identity disorder report more positive symptoms of schizophrenia than do schizophrenics, while schizophrenics report more negative symptoms, a primary emphasis on positive symptoms may result in false-positive diagnoses of schizophrenia and false-negative diagnoses of dissociative identity disorder.

Adult↗
PubMed1997

Two-year follow-up of inpatients with dissociative identity disorder.

OBJECTIVE: A group of 135 inpatients with dissociative identity disorder was followed for 2 years to monitor treatment outcome. METHOD: Fifty-four of the patients were located and reassessed after a 2-year period through the use of the same self-report measures and structured clinical interviews that had been initially administered. RESULTS: The patients showed marked improvement on Schneiderian first-rank symptoms, mood and anxiety disorders, dissociative symptoms, and somatization, with a significant decrease in the number of psychiatric medications prescribed. Patients who were treated to integration were significantly more improved than those who had not yet reached integration. CONCLUSIONS: These findings, although preliminary, provide empirical validation of previous clinical impressions that patients with dissociative identity disorder may respond well to treatment.

Adult↗
PubMed1996

Structured interview data on 35 cases of dissociative identity disorder in Turkey.

OBJECTIVE: The aim of this study was to describe the clinical features of dissociative identity disorder in a group of Turkish patients as assessed with a structured interview. METHOD: Thirty-five consecutive patients at the dissociative disorders program of a university psychiatric clinic who met the DSM-IV criteria for dissociative identity disorder were included in this study. The subjects were assessed with the Turkish versions of the Dissociative Disorders Interview Schedule and the Dissociative Experiences Scale. A descriptive analysis of the clinical features was carried out. RESULTS: Most (88.6%) of the patients were women. The mean age of the group was 22.8 years. Childhood physical or sexual abuse was reported by 77.1% of the patients. The mean Dissociative Experiences Scale score was 49.1. The patients reported an average of 12.5 somatic symptoms, 6.2 Schneiderian symptoms, 10.0 secondary features of the disorder, 3.8 borderline personality disorder criteria, and 4.1 extrasensory experiences. CONCLUSIONS: Dissociative identity disorder has a stable, consistent set of features throughout North America, in the Netherlands, and in Turkey. Cross-cultural research using standardized assessment measures will be invaluable in further illumination of the validity of this widely neglected psychiatric category.

Borderline Personality Disorder↗
PubMed1995

Hypnosis, childhood trauma, and dissociative identity disorder: toward an integrative theory.

It is contended that prevailing exogenous trauma theory provides in most cases neither a sufficient nor a necessary explanation for the current large number of diagnosed cases of dissociative identity disorder (multiple personality disorder) and related dissociative syndromes purported to have arisen as a response to severe early childhood physical and sexual abuse. Relevant aspects of instinctual drive theory, ego psychology, object relations theory, self psychology, social psychological theory, sociocultural influences, and experimental hypnosis findings are drawn on to demonstrate the importance of adopting a more integrative theoretical perspective in the diagnosis and treatment of severe dissociative syndromes. Further cooperative experimental and clinical research on the etiology, prevalence, and clinical manifestations of the group of dissociative disorders is strongly encouraged.

Adult↗
PubMed1998

Dissociative identity disorder: an Australian series.

OBJECTIVE: Series of patients fulfilling diagnostic criteria for Dissociative Identity Disorder (DID), otherwise known as multiple personality disorder, have particularly been reported on in North America and increasingly in other countries. The present study investigated the trauma and past treatment histories, symptom profiles and dissociative phenomenology of 62 patients fulfilling diagnostic criteria for DID seen in Brisbane (Queensland, Australia). METHOD: From 1992, systematic assessments, including the Dissociative Experience Scale and the Dissociative Disorders Interview Schedule, were performed with a personal series of 57 patients with DID seen by one of the authors (WM) and five patients seen by the second author (JB). RESULTS: The histories of childhood trauma, the clinical profiles and dissociative indices of these patients closely approximate those described in series reported in other countries. CONCLUSIONS: Patients fulfilling diagnostic criteria for DID are regularly seen in Australian inpatient and outpatient settings. The dissociative symptomatology of the patients examined in the present study represents a significant component of a complex syndrome associated with a history of severe ongoing developmental trauma dating from early childhood.

Adolescent↗