Dissociative identity disorder.
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Diagnostic and Statistical Manual of Mental Disord↗
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The sociocognitive model of dissociative identity disorder: a reexamination of the evidence.
According to the sociocognitive model of dissociative identity disorder (DID; formerly, multiple personality disorder), DID is not a valid psychiatric disorder of posttraumatic origin; rather, it is a creation of psychotherapy and the media. Support for the model was recently presented by N.P. Spanos (1994). In this article, the author reexamines the evidence for the model and concludes that it is based on numerous false assumptions about the psychopathology, assessment, and treatment of DID. Most recent research on the dissociative disorders does not support (and in fact disconfirms) the sociocognitive model, and many inferences drawn from previous research appear unwarranted. No reason exists to doubt the connection between DID and childhood trauma. Treatment recommendations that follow from the sociocognitive model may be harmful because they involve ignoring the posttraumatic symptomatology of persons with DID.
Adult↗
Transient dissociative identity disorder after electroconvulsive therapy.
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Adult↗
Dissociative identity disorder: diagnosis and treatment in the Netherlands.
Dissociative Identity Disorder (DID) is a controversial diagnosis and empirical data on the efficacy of treatment modalities are scanty. The objective of this study was to explore the frequency of the diagnosis, the types and efficacy of prevailing treatment practices, and to examine demographic data on patients in the Netherlands. A questionnaire, including questions on one selected DID patient, was mailed to 1,452 Dutch psychiatrists. The response rate was 46.7%. A total of 273 psychiatrists reported having made the diagnosis at least once. The diagnosis was made in a statistically significant manner more frequently by female psychiatrists, by psychiatrists aged 50 years or younger, and by those certified after 1982. No correlation was observed with primary theoretical orientation or the type or topography of work facility. The mean age of the selected patients was 33.2 and the male:female (M:F) ratio 1:9. The majority of patients were seen once a week in an outpatient setting. Individual psychotherapy and adjunctive anxiolytic or antidepressant medications were the most widely endorsed treatment modalities. Hypnosis was rarely used. We conclude that the diagnosis of DID is not to be dismissed as a local eccentricity. It is warranted as an explanatory framework in the context of a psychotherapeutic treatment.
Adult↗
Dissociative identity disorder: a literature review.
This paper presents a review of the literature into dissociative identity disorder. This disorder, previously known as multiple personality disorder, is increasingly diagnosed, in part because of more focused diagnostic tools, but also because people are accessing services to assist with the longterm problems of early child abuse and neglect. Dissociative identity disorder is examined in the literature according to a variety of discourses, each of which suggest different ways of conceptualizing problems and therapeutic approaches. These discourses reviewed include: psychiatry, psychology, corporeality, feminism, social constructivism, anthropology, and postmodernism. The paper concludes with an examination of the nursing literature and suggests opportunities for nursing research into this complex mental health problem.
Dissociative Identity Disorder↗
Dissociative identity disorder and pseudo-hysteria.
The diagnostic validity of dissociative identity disorder (DID) continues to inspire controversy, with some commentators claiming that DID is a modern variant of "hysteria"; that is, attention-seeking behavior. The author asserts that DID is indeed a valid psychiatric disorder, and believes that this skeptical reaction can largely be attributed to a specific set of transference/countertransference interactions that these patients tend to inspire. The paper delineates several clinical features of DID that can easily be mistaken for hysterical phenomena, and attempts to find the roots of this confusion in the DID patients' experience of interpersonal powerlessness, which leads them to present their symptoms in an unconvincing, "hysterical" manner. Confusion between the vertical split seen in the dissociative disorders and the horizontal split characteristic of the classic hysterical personality is discussed, as is the powerful effect of observer bias in creating hysterical-appearing phenomena. The term "pseudo-hysteria" is used to denote a situation in which a genuine psychiatric disorder, DID, is perceived as an hysterical production.
Diagnosis, Differential↗
Effectiveness of treatment for dissociative identity disorder.
In a recent study by Ellason and Ross, patients with Dissociative Identity Disorder reported a decrease in symptoms on the Millon Clinical Multiaxial Inventory-II over a 2-yr. follow-up period. Patients judged to have achieved integration of their personalities rated themselves as more substantially improved on the Millon-II than did patients judged not to have achieved integration. Ellason and Ross suggested that this improvement reflected the influence of treatment; however, for several reasons, their findings are open to alternative interpretations. First, in the absence of proper control conditions, one cannot rule out the contribution of other factors to the over-all improvement of patients such as regression of symptoms toward the mean following the initial assessment. Second, patients self-reported improvement was less substantial when data were reanalyzed using more appropriate statistical criteria. Third, the greater improvement observed among integrated patients relative to nonintegrated patients may reflect influences other than differential responsiveness to treatment, such as less severe pathology prior to treatment. More systematic research is needed to clarify the effect of treatment on Dissociative Identity Disorder.
Defense Mechanisms↗
Interidentity amnesia for neutral, episodic information in dissociative identity disorder.
Interidentity amnesia is considered a hallmark of dissociative identity disorder (DID) in clinical practice. In this study, objective methods of testing episodic memory transfer between identities were used. Tests of both recall (interference paradigm) and recognition were used. A sample of 31 DID patients was included. Additionally, 50 control subjects participated, half functioning as normal controls and the other half simulating interidentity amnesia. Twenty-one patients subjectively reported complete one-way amnesia for the learning episode. However, objectively, neither recall nor recognition scores of patients were different from those of normal controls. It is suggested that clinical models of amnesia in DID may be specified to exclude episodic memory impairments for emotionally neutral material.
Adult↗
Dissociative identity disorder in psychiatric inpatients.
OBJECTIVE: The aim of this study was to replicate reports of a high rate of dissociative identity disorder in psychiatric inpatients. METHOD: Subjects were 100 randomly selected women, 16-50 years old, who had recently been admitted to an acute psychiatric hospital. Diagnoses were made by two interviewers through use of the Structured Clinical Interview for DSM-IV Dissociative Disorders. RESULTS: One percent (N = 1) of the interviewed subjects had dissociative identity disorder. CONCLUSIONS: Contrary to previous studies, the authors found a low rate of dissociative identity disorder, perhaps because of the different methodology used.
Adolescent↗
Autobiographical memory across personalities in dissociative identity disorder: a case report.
A core feature of dissociative identity disorder (DID) is the amnesia that exists between personalities. This study investigated autobiographical memory in a patient, HS, prior to and after her diagnosis with DID. This diagnosis was associated with increased recall of traumatic memories that were reported by a child personality. The child personality was able to recognize only half of the memories reported by the host personality. HS's responses were dissimilar to responses of control and nonexperiment participants. These findings suggest that DID is associated with alterations in autobiographical memory and that memories differ across personalities. Results are discussed in terms of memory and pseudomemory development in DID.
Adult↗
The objective assessment of amnesia in dissociative identity disorder using event-related potentials.
Assessment of amnesia in Dissociative Identity Disorder (DID) typically relies on self-report, the veracity of which cannot often be independently verified. Memory in DID was therefore assessed using an objective method that involved event-related potentials (ERPs) as well as indirect behavioral measures of memory, and that provided statistically supported assessments for each participant. Four participants who met DSM-IV criteria for DID participated in an ERP memory assessment task, in which words learned by one identity (identity A) were then presented to a second identity (identity B). All four participants - tested as identity B - produced ERP and behavioral evidence consistent with recognition of the material learned by identity A. While it would be premature to generalize all cases of DID, the results suggest that there may be reasons to question the veracity of reports by individuals who meet diagnostic criteria for DID on the basis of a structured clinical interview.
Adult↗
Treating the traumatic memories of patients with dissociative identity disorder.
OBJECTIVE: The author uses clinical experience informed by research findings to suggest approaches to the treatment of the traumatic memories of patients with dissociative identity disorder. METHOD: Recent findings in the treatment of patients with this disorder and current considerations with regard to memories of childhood trauma are used to develop recommended approaches. RESULTS: Treatment of traumatic memories appears crucial in the recovery of patients with dissociative identity disorder, even though the reported memories may not be historically accurate. Criteria are available for determining whether a patient with the disorder is able to undertake such efforts, and methods such as fractionated abreaction have been developed to make the process less unsettling. CONCLUSIONS: Despite the difficulties posed by the vulnerability of patients with dissociative identity disorder to decompensation when working with traumatic material and the vicissitudes of autobiographical memory, modern therapeutic approaches allow the processing of such patients' traumatic material in a manner that reduces the likelihood of disruptive events and the misuse of recovered material.
Abreaction↗
Assessment of genuine and simulated dissociative identity disorder on the structured interview of reported symptoms.
Little is known about how to detect malingered dissociative identity disorder (DID). This study presents preliminary data from an ongoing study about the performance of DID patients on the Structured Interview of Reported Symptoms (SIRS, Rogers, Bagby, & Dickens, 1992), considered to be a "gold standard" structured interview in forensic psychology to detect feigning of psychological symptoms. Test responses from 20 dissociative identity disorder (DID) patients are compared to those of 43 well informed and motivated DID simulators. Both the simulators and DID patients endorsed such a high number of symptoms that their average overall scores would typically be interpreted as indicative of feigning. The simulators' mean scores were significantly higher than those of the DID patients on only four out of 13 scales. These results provide preliminary evidence that well informed and motivated simulators are able to fairly successfully simulate DID patients and avoid detection on the SIRS. Furthermore, many DID patients may be at risk for being inaccurately labeled as feigning on the SIRS.
Adult↗
The detection of dissociative identity disorder by Northern Irish clinical psychologists and psychiatrists: a clinical vignettes study.
A sample of Northern Irish clinical psychologists (N=27) and psychiatrists (N=29) completed three clinical vignettes designed to assess the detection of dissociative identity disorder. Data suggested that psychiatrists and clinical psychologists were better able to detect dissociative identity disorder when discriminating and characteristic symptoms were present. However, the majority of clinicians still failed to diagnose dissociative identity disorder as the most likely condition in a clear-cut case.
Adult↗
[Identity and dissociation in cyberspace. A case of dissociative identity disorder associated with internet role playing].
OBJECTIVE: By mediating dissociative experiences, the Internet can challenge the boundaries of people's sense of identity. To illustrate this hypothesis, a case of dissociative identity disorder (DID) is presented. CLINICAL PICTURE: A young unemployed woman created and frequently played several characters in an online game. For more than 2 years she spent up to 12 h a day in the Internet, assuming various personalities, which in return intruded upon her neglected real life. TREATMENT AND OUTCOME: During the course of an inpatient psychotherapeutic treatment, the clinical diagnosis of DID was confirmed by psychometric testing. After 12 weeks of psychotherapy, the patient had managed to identify her fragmented identities as character traits and integrated them into her core personality. She rearranged her real everyday life, found a new job, and reduced her online activities. DISCUSSION: Even though the patient's psychopathology stems from a disposition in terms of a personality disorder with histrionic and narcissistic features, excessive internet role play obviously functioned as a trigger to develop DIS. Conclusively, cyberspace's anonymous interactivity may offer the possibility to explore one's identity while also putting at risk its coherence.
Adult↗
The relational treatment of dissociative identity disorder.
The intent of this paper is to review the literature pertaining to the transference and countertransference components in the treatment of dissociative identity disorder. Aspects of transference and countertransference are presented and discussed within the relational psychoanalytic model. The functions of empathy, enactment, projective identification, and transitional objects are reviewed. Specific attitudes in the transference and countertransference are illuminated and major transference themes are discussed. Finally, a case vignette illustrates some of the central issues involved in the treatment of dissociative identity disorder.
Countertransference↗
Rorschach indicators of dissociative identity disorders: clinical utility and theoretical implications.
The purpose of the present study was to replicate Rorschach signs of Multiple Personality Disorder (MPD) using DSM-IV criteria of Dissociative Identity Disorder (DID). Women admitted to either an inpatient dissociative disorder's unit (n = 27) or a general psychiatric unit (n = 72) were given the Rorschach, which was scored for the Labott, Barach, and Wagner Rorschach markers of MPD. Results indicated that Rorschach signs of the three different systems were significantly better than chance at classifying patients as DID or as non-DID. The Labott system, which performed the best, was able to accurately classify 92% of the sample. These results argue for the validity of the DID diagnosis. The Rorschach signs operate independent of external bias, yet correspond to the diagnoses obtained through psychiatric evaluation in an inpatient setting. The fact that two relatively rare sets of signs (DID and Rorschach) converge in the same small sector of the psychiatric population represents evidence of linkage that is clinically meaningful and not explainable on the basis of artificial creation.
Adolescent↗
Identity state-dependent attentional bias for facial threat in dissociative identity disorder.
Biased attention for threatening stimuli has been associated with many forms of psychopathology. Attention to threatening faces presented below perceptual thresholds was assessed in patients diagnosed with dissociative identity disorder using a pictorial emotional Stroop task. Patients were tested in two different identity states, in one of which they claimed strong awareness of trauma. Attentional bias for social threat proved state-dependent in the patients and deviated from the patterns observed in controls.
Adult↗