Fact or factitious? A psychobiological study of authentic and simulated dissociative identity states.

A A T S Reinders,Herry P J Vos,Antoon T M Willemsen,Johan A Den Boer,Ellert R S Nijenhuis,Jerson Laks

doi:10.1371/journal.pone.0039279

A A T S Reinders, Herry P J Vos + Show 4 more

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https://doi.org/10.1371/journal.pone.0039279

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Abstract

BackgroundDissociative identity disorder (DID) is a disputed psychiatric disorder. Research findings and clinical observations suggest that DID involves an authentic mental disorder related to factors such as traumatization and disrupted attachment. A competing view indicates that DID is due to fantasy proneness, suggestibility, suggestion, and role-playing. Here we examine whether dissociative identity state-dependent psychobiological features in DID can be induced in high or low fantasy prone individuals by instructed and motivated role-playing, and suggestion.Methodology/Principal FindingsDID patients, high fantasy prone and low fantasy prone controls were studied in two different types of identity states (neutral and trauma-related) in an autobiographical memory script-driven (neutral or trauma-related) imagery paradigm. The controls were instructed to enact the two DID identity states. Twenty-nine subjects participated in the study: 11 patients with DID, 10 high fantasy prone DID simulating controls, and 8 low fantasy prone DID simulating controls. Autonomic and subjective reactions were obtained. Differences in psychophysiological and neural activation patterns were found between the DID patients and both high and low fantasy prone controls. That is, the identity states in DID were not convincingly enacted by DID simulating controls. Thus, important differences regarding regional cerebral bloodflow and psychophysiological responses for different types of identity states in patients with DID were upheld after controlling for DID simulation.Conclusions/SignificanceThe findings are at odds with the idea that differences among different types of dissociative identity states in DID can be explained by high fantasy proneness, motivated role-enactment, and suggestion. They indicate that DID does not have a sociocultural (e.g., iatrogenic) origin.

Highlights

Despite its inclusion in the Diagnostic Manual for Mental Disorders [1], the genuineness of dissociative identity disorder (DID) continues to be disputed
DID patients, as well as high fantasy prone and low fantasy prone controls were studied in the two different types of identity states during a memory script (MS) driven imagery paradigm
Neither high nor low fantasy prone healthy controls, instructed and motivated to simulate two different types of dissociative identity states in DID (i.e., neutral identity state (NIS) and trauma-related identity state (TIS)), mimicked previously observed psychophysiological and neural reactions that are associated with these identity states in DID [39,40], which is supportive of our first a priori hypothesis

Summary

Introduction

Despite its inclusion in the Diagnostic Manual for Mental Disorders [1], the genuineness of dissociative identity disorder (DID) continues to be disputed. The non-trauma-related position [2,3,7,11,12,13], referred to as the sociocognitive model of DID [14,15,16], holds that DID is a simulation caused by high suggestibility and/or fantasy proneness [17,18,19,20,21], suggestive psychotherapy and other suggestive sociocultural influences (e.g., the media and/or the church) According to this model, ‘‘[t]he rules for enacting the [DID] role [...] are as follows: (a) Behave as if you are two (or more) separate people who inhabit the same body. We examine whether dissociative identity state-dependent psychobiological features in DID can be induced in high or low fantasy prone individuals by instructed and motivated role-playing, and suggestion

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