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PubMed2004

The persistence of folly: a critical examination of dissociative identity disorder. Part I. The excesses of an improbable concept.

OBJECTIVE: To examine the concept of dissociative identity disorder (DID). METHOD: We reviewed the literature. RESULTS: The literature shows that 1) there is no proof for the claim that DID results from childhood trauma; 2) the condition cannot be reliably diagnosed; 3) contrary to theory, DID cases in children are almost never reported; and 4) consistent evidence of blatant iatrogenesis appears in the practices of some of the disorder's proponents. CONCLUSIONS: DID is best understood as a culture-bound and often iatrogenic condition.

Adult↗
PubMed1995

Assessment of dissociative identity disorder with the Million Clinical Multiaxial Inventory-II.

96 patients with a clinical diagnosis of Dissociative Identity Disorder were administered the Million Clinical Multiaxial Inventory-II. The most elevated personality disorder scales were Avoidant, Self-defeating, Borderline, and Passive-Aggressive personality disorders. Elevated Axis I scales included Dysthymia, Major Depression, Thought Disorder, and Anxiety Disorder. Million-II profiles of a patient before and after integration showed normalization of a previously pathological profile.

Adolescent↗
PubMed2005

A proposed trial of dialectical behavior therapy and trauma model therapy.

Dissociative identity disorder and borderline personality disorder resemble each other in trauma histories and comorbidity. Each disorder is frequently comorbid with the other. Treatment outcome data for Dialectical Behavior Therapy of borderline personality disorder and Trauma Model Therapy of dissociative identity disorder are reviewed. The author proposes a psychotherapy treatment study in which there are three subject groups and two treatment conditions. The subject groups are borderline personality disorder without dissociative identity disorder; dissociative identity disorder without borderline personality disorder; and both conditions present concurrently. Subjects would be randomized to receive Dialectical Behavior Therapy or Trauma Model Therapy. Such a study could provide answers to controversies in the field about a better treatment approach for dissociative identity disorder and potentially could broaden and strengthen the indications for Dialectical Behavior Therapy.

Adult↗
PubMed1997

Dissociative identity disorder: a feminist approach to inpatient treatment using Jean Baker Miller's Relational Model.

Women diagnosed with Dissociative Identity Disorder (DID) may experience episodic crises characterized by intense states of disconnection from self and others. Crises which result in potential harm to self/others may require inpatient treatment. With economic emphasis on shorter lengths of stay, a treatment program or model which focuses on the DID patient's sense of connectedness to self and others can enhance treatment efforts during brief inpatient hospitalizations. The Relational Model of Jean Baker Miller uses mutuality and empowerment within the therapeutic relationship and inpatient mileu to move the patient beyond therapeutic impasse/crisis toward a state of greater connectedness to self and others.

Adult↗
PubMed1998

Identifying dissociative identity disorder: a self-report and projective study.

This study compared 21 female adult psychiatric patients diagnosed with dissociative identity disorder (DID) with 21 female adult nondissociative psychiatric patients to determine whether DID patients exhibit a distinguishing set of clinical features, and perceptual, attentional, and cognitive processes. Participants were assessed with the Dissociative Disorders Interview Schedule to assess diagnostic status. Group scores on the Dissociative Experiences Scale, Tellegen Absorption Scale, Childhood Trauma Questionnaire, Brief Symptom Inventory, and the Rorschach test were compared. DID participants reported earlier and more severe childhood trauma, more dissociative symptoms, and a greater propensity for altered states of consciousness. The DID participants also exhibited increased projective and imaginative activity, a diminished ability to integrate mental contents, a complex and driven cognitive style, and a highly unconventional view of reality.

Adult↗
PubMed2006

Dissociative identity disorder presenting as dermatitis artefacta.

Dermatitis artefacta is a rare psychiatric condition characterized by rubbing of skin blisters and denial of self-infliction. Dissociation may be comorbid with self-injurious behavior. A background of emotional disturbances during formative years and in later life often results in feelings of isolation and insecurity, which can lead to dissociation as a primary defense mechanism used to overcome traumatic events. In this case report, we describe a female patient with dermatitis artefacta associated with dissociative identity disorder. The patient was a 14-year-old girl. Multiple large, deep ulcerations with unnatural shapes were seen on her left forearm. The ulcerations were thought to be self-inflicted. Psychiatric examination revealed that she had a different identity, and inflicted the lesions when this was assumed. This case leads us to suggest that patients with dermatitis artefacta might have comorbid dissociative experiences, which cannot be identified easily.

Adolescent↗
PubMed1999

Dissociative identity disorder and the sociocognitive model: recalling the lessons of the past.

In a recent article in this journal, D. H. Gleaves (1996) criticized the sociocognitive model (SCM; N. P. Spanos, 1994) of dissociative identity disorder (DID) and argued in favor of a posttraumatic model (PTM) in which DID is conceptualized as a consequence of childhood abuse and other traumatic events. The present authors demonstrate that (a) many of Gleaves's arguments were predicated on misunderstandings of the SCM, (b) scrutiny of the evidence regarding the psychopathology and assessment of DID raises questions concerning the PTM's conceptual and empirical underpinnings, (c) the treatment literature suggests that iatrogenic factors play an important role in the etiology of DID, and (d) the evidence linking child abuse to DID is more problematic than implied by Gleaves. The present authors conclude that Gleaves's analysis underemphasized the cultural manifestations of multiple role enactments and that the history of DID imparts a valuable lesson to contemporary psychotherapists.

Adult↗
PubMed2002

Alters in dissociative identity disorder. Metaphors or genuine entities?

How should the different identities (i.e., alters) that are thought to be typical for dissociative identity disorder (DID) be interpreted? Are they just metaphors for different emotional states or are they truly autonomous entities that are capable of willful action? This issue is important because it has implications for the way in which courts may handle cases that involve DID patients. Referring to studies demonstrating that alters of DID patients differ in their memory performance or physiological profile, some authors have concluded that alters are more than just metaphors. We argue that such line of reasoning is highly problematic. There is little consensus among authors about the degree to which various types of memory information (implicit, explicit, procedural) may leak from one to the other alter. Without such theoretical accord, any given outcome of memory studies on DID may be taken as support for the assumption that alters are in some sense "real." As physiological studies on alter activity often lack proper control conditions, most of them are inconclusive as to the status of alters. To date, neither memory studies nor psychobiological studies have delivered compelling evidence that alters of DID patients exist in a factual sense. As a matter of fact, results of these studies are open to multiple interpretations and in no way refute an interpretation of alters in terms of metaphors for different emotional states.

Amnesia↗
PubMed2002

Moral status and the treatment of Dissociative Identity Disorder.

Many contemporary bioethicists claim that the possession of certain psychological properties is sufficient for having full moral status. I will call this the psychological approach to full moral status. In this paper, I argue that there is a significant tension between the psychological approach and a widely held model of Dissociative Identity Disorder (DID, formerly Multiple Personality Disorder). According to this model, the individual personalities or alters that belong to someone with DID possess those properties that proponents of the psychological approach claim suffice for full moral status. If this account of DID is true, then the psychological approach to full moral status seems to entail that the two standard therapies for treating DID might, on occasion, be seriously immoral, for they may well involve the (involuntary) elimination of an entity with full moral status. This result should give proponents of the psychological approach pause, for most people find the claim that current treatments of DID are ethically suspect highly counter-intuitive.

Dissociative Identity Disorder↗
PubMed1997

Clinical hypnosis for rapid recovery from dissociative identity disorder.

Numerous anecdotal reports and textbooks from distinguished mental health practitioners have accorded to clinical hypnosis a prominent role in the successful psychotherapeutic treatment of Dissociative Identity Disorder (DID). This ideographic inquiry of one such treatment offers empirical support for the instrumental effects of clinical hypnosis with a highly hypnotizable patient who alleged intermittent sexual abuse during the 2-5 age range. Multiple pre- and post-intervention measures, plus treatment trajectory monitoring and explication, demonstrate how hypnosis methodology contributed to a rapid recovery from DID. Future research is called for to further elucidate the therapeutic benefits of clinical hypnosis for DID patients having different levels of hypnotizability and treatment responsiveness.

Adult↗
PubMed2001

Dissociative identity disorder and the nurse-patient relationship in the acute care setting: an action research study.

This paper presents the results of an action research study into the acute care experience of Dissociative Identity Disorder. The study, which was grounded in principles of critical social science, utilized focus group interviews and narrative construction. Nurses and patients are under-represented in all clinical evaluation and their voices need to be heard if services are to be truly collaborative. Findings of the study extend intrapsychic theories of trauma to emphasize the interpersonal relationship between nurse and person who can work together to facilitate recovery from trauma, make connections both intra and interpersonally and build resilience.

Acute Disease↗
PubMed2004

Procedural memory in dissociative identity disorder: when can inter-identity amnesia be truly established?

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.

Amnesia↗
PubMed1995

Vulnerability Scale scores in female inpatients diagnosed with self-injurious behaviour, dissociative identity disorder, and major depression.

For three groups of predominantly female inpatients scores on the Glover Vulnerability Scale were compared with each other and with those of a control sample. The four groups included individuals who were diagnosed with self-injurious behavior, females diagnosed with Dissociative Identity Disorder, females whose predominant diagnosis was Major Depressive Disorder, and female controls. Females with a trauma-related diagnosis (Groups 1 and 2) scored higher on the Glover Vulnerability Scale than Group 3. History of exposure to trauma or childhood abuse most clearly discriminated higher scores within the control sample. The findings highlighted the close relationship between histories of exposure to trauma and high scores on this scale. Additional analysis of these scores and those on the Glover Numbing Scale showed a close association between feelings of vulnerability and the numbing response.

Adult↗