Dissociative Identity Disorder Patients Research Articles

A Meta-analysis on Childhood Trauma Involved in Dissociative Identity Disorder

Dissociative identity disorder (DID) is a psychobiological syndrome referred to the appearance of extra identities and memories which cause the changes in cognize and behaviour. Evidence has shown that early childhood trauma plays a key role in the genesis of DID. This paper compiles and analyzes the amount of emotional and physical neglect and abuse as well as sexual abuse in DID patients early childhood. Evidence shows that DID patients report more experience in every type of trauma than healthy people. Then a meta-analysis is made to illustrate the influence of different types of traumatization on DID patients, giving a result that the origin of DID is more likely comes from emotional abuse and neglect, followed by sexual abuse, and is least likely to come from physical abuse and neglect.

Assessing malingering and personality styles in dissociative identity disorder: a case study

ABSTRACT Dissociative Identity Disorder (DID), formerly Multiple Personality Disorder, involves two or more distinct identities controlling behaviour, stemming from trauma-related dissociation. Understanding DID’s cognitive, neural, and psychometric aspects remains a challenge, especially in distinguishing genuine cases from malingering. We present a case of a DID patient with nine identities, evaluated to rule out malingering. Using the Millon Index of Personality Styles, we assessed the primary and two alternate identities, revealing marked differences. High consistency scores support validity. We suggest employing personality inventories beyond symptomatology to characterise dissociative identities’ consistency and adaptation styles, aiding in malingering assessments in future studies.

Understanding Dissociative Identity Disorder: A Literature Review

Interest in dissociative identity disorder (DID) in psychiatry has increased rapidly although epidemiologically the cases of patients with DID are still rare, several studies exist trying to understand how DID might occur and the best therapeutic approach. Some of the symptoms of DID can also be found in non-clinical populations even though they are not directly related to the disorder. The findings of DID are often associated with other psychiatric disorders and can complicate the diagnosis. Various studies have tried to understand the case of DID either objectively or subjectively. Diagnosis of DID must be diagnosed by carefully experienced clinicians with clinical interviews with some proper tests that could help to identify various identities. Current DID therapy may be able to strengthen the identity of the patient’s control and prevent impaired social functioning of the patient. Many pharmacological and non-pharmacological treatments have been developed to improve symptoms of the disorder, but none of them have been effective due to the quality of the studies conducted. Further research is still needed on DID as a whole to assist in the correct diagnosis and therapy for DID patients.

The Dissociation-Related Beliefs About Memory Questionnaire (DBMQ): Development and psychometric properties.

Discontinuities in memory are the hallmark symptoms of most dissociative disorders but are also reported by patients diagnosed with related disorders, including PTSD. Memory discontinuity is most evident in dissociative identity disorder (DID), where patients may report amnesia in 1 identity for information available in other identities (i.e., interidentity amnesia). Studies indicate that even though patients subjectively report interidentity amnesia for material learned in, or pertaining to, another identity, objective findings show evidence of transfer of that material between identities. Subjective reports of dissociative amnesia may be explained by specific dissociation-related metamemory beliefs, which hinder voluntary retrieval, personal acknowledgment, and processing of memories. This study aimed to develop a questionnaire indexing metamemory beliefs related to trait dissociation. Two studies in nonclinical populations provided information about the factor structure (Studies 1 and 2) of the newly developed Dissociation-related Beliefs about Memory Questionnaire (DBMQ). Information was also provided about the construct validity (Studies 2 and 3), and reliability of the scale (all 3 studies) in nonclinical as well as a clinical population. Results indicated sound psychometric properties of a short 16-item DBMQ with subscales assessing Fragmentation, Positive beliefs about amnesia, Lack of self-reference, and Fear of losing control, and correlations specifically with trait dissociation and posttraumatic avoidance symptoms. A sample of DID patients (N = 19) showed increased scores on the DBMQ. The DBMQ provides a short, reliable, and valid tool for indexing dissociation-related metamemory beliefs. These beliefs were associated with trait dissociation and posttraumatic avoidance symptoms. (PsycInfo Database Record (c) 2023 APA, all rights reserved).

Analysis of Demographic and Clinical Characteristics of Patients with Dissociative Identity Disorder.

The prevalence of dissociative identity disorder (DID) is 1%. However, the diagnosis can be made less frequently. This rate is similar to that of schizophrenia, and it is a public health problem that should receive attention. In the wake of the research results and clinical experiences, it was determined that DID diagnosis was challenging. Despite prevalence rates being similar to those seen in schizophrenia, DID remains under-researched. This study aims to determine the sociodemographic features, complaints, aetiological traumas, comorbid psychiatric disorders, and previous psychiatric applications of patients who had DID diagnosis, as well as to increase the awareness and recognisability of DID. Seventy patients who were diagnosed with DID based on the DSM 5 criteria and admitted to the outpatient clinic of the Department of Psychiatry Harran University Faculty of Medicine agreed to participate in this study. Patients filled out dissociative experiences scale, dissociation scale, and sociodemographic data form. Of the 70 patients, 47 (67.14%) were female, and 23 (32.85%) were male. The mean age was 26.5 ± 9.63, the age range was 18-62. It was the first psychiatric application for 34 (48.57%) patients. Of the 70 patients, 27 (38.57%) had four or more applications. Only 17 patients (24.28%) had the sole diagnosis of DID, while 47 patients (67.14%) had comorbid depressive symptoms. Regarding the first complaints, 35 patients (50.00%) had dissociative symptoms; 49 patients (70.00%) had depressive symptoms. As for the trauma types, 45 patients (64.28%) had histories of physical abuse, while 34 patients (48.57%) had histories of chronic neglect. The symptoms of DID can be related to many psychiatric disorders. DID patients can be classified under many different symptom groups. Treatments for symptoms fail when the diagnosis of DID is neglected. Patients are generally misdiagnosed, as determined in this study and in previous studies. Dissociative symptoms should be checked regularly during psychiatric interviews to prevent misdiagnosis.

Dissociative Identity Disorder and the Law: Guilty or Not Guilty?

Dissociative identity disorder (DID) is a dissociative disorder that gained a significant rise in the past few decades. There has been less than 50 DID cases recorded between 1922 and 1972, while 20,000 cases are recorded by 1990. Therefore, it becomes of great significant to assess the various concepts related to DID to further understand the disorder. The current review has a goal of understanding whether an individual suffering from DID is legally responsible for the committed crime, and whether or not he or she can be considered competent to stand trial. These two questions are to be raised in understanding DID, by first shedding a light on the nature of the disorder and second by examining the past legal case examples. Despite the very nature of the disorder is characterized by dissociative amnesia and the fact that the host personality may have limited or no contact with the alters, there is no consensus within the legal system whether the DID patients should be responsible for their actions. Further to that, courts generally deny the insanity claims for DID suffering patients. In conclusion, more studies in the field are suggested to incorporate primary data into research, as the extensive reliance on secondary data forces us to believe the conclusions that were previously made, and no opportunity to verify those conclusions is present.

Dissociative Identity Disorder: Diagnostic Accuracy and DSM-5 Criteria Change Implications

ABSTRACT The Diagnostic and Statistical Manual of Mental Disorders, 5th Edition (DSM-5) revised the diagnostic criteria for dissociative identity disorder (DID) to more accurately reflect the symptom profile of DID patients. No study has examined how this change affects clinical diagnosis of DID. The present study examined clinician reports of patient symptoms in relation to DSM-IV-TR and DSM-5 DID diagnostic criteria. Data were analyzed from 169 clinicians who participated in the Treatment of Patients with Dissociative Disorders Network Study with a patient they assigned a DID diagnosis. Clinicians evaluated their patients with respect to DSM-IV-TR and DSM-5 DID diagnostic criteria. Researchers determined a clinician-assigned DID diagnosis as “accurate” when the patient’s reported dissociative symptoms matched DSM-IV-TR and/or DSM-5 criteria for DID. Most of the clinicians (95.27%) accurately diagnosed DID. Of those accurately diagnosed, 83.85% of patients met DSM-IV-TR and DSM-5 DID criteria, 9.94% only met DSM-IV-TR DID criteria, and 6.21% only met DSM-5 DID criteria. Further examination of responses suggested that possible idiomatic responses to the negative wording of the DSM-5 exclusionary criteria might have accounted for the DSM-IV-TR appearing to fit for a greater number of cases in this study. Changes in the DSM criteria for DID did not substantially change the frequency or accuracy of assigned DID diagnoses, but the removal of the requirement in DSM-5 that self-states regularly take control of an individual’s behavior slightly increased the number of individuals meeting criteria for DID.

Divided mind – divided brain. The neurobiology of dissociative identity disorder from the perspective of dynamical systems theory

Explaining the biology of dissociative identity disorder and its clinical aspects is one of the major challenges in modern neuroscience. The complexity and the unique nature of this disorder, coupled with insufficient biopsychological models needed for creating universal therapeutic procedures, make the treatment difficult. The vast majority of neuroimaging studies in dissociative identity disorder patients proved to be inconclusive. Abnormalities of particular brain structures do not explain the wide range of symptoms in dissociative identity disorder. Moreover, the findings are partly contradictory. Collecting adequate representative study samples is difficult and most reports are in fact single case studies. On top of that, meta-analyses show that patients with dissociative identity disorder usually present with additional mental problems, which makes interpretation of neuroimaging data extremely difficult. Nowadays, scientific research on dissociative identity disorder focuses on child trauma and its influence on the development of the central nervous system. This article is an overview of recent research on the neurobiology of dissociative identity disorder, with particular emphasis on the impact of childhood trauma on the development of the central nervous system. It focuses on hypotheses attempting to capture the specific dynamics of neural activity leading to neural network fragmentation, and uses the dynamical systems theory to describe this phenomenon.

The gordian knot of overlapping symptoms between dissociative identity disorder and borderline personality disorder, the need for a clear cut: A case report

IntroductionOne of the central debates in the psychiatric community is the difficulty in distinguishing Dissociative Identity Disorder (DID) from Borderline Personality Disorder (BPD). The fact that core symptoms of these pathologies such as emotional dysregulation, alterations in sense of Self, amnesia, depersonalization, self harm, hearing voices, difficulties in maintaining relationships, are symptoms that feature in both disorders can lead physicians to a misdiagnosis, thus depriving patients with DID of adequate treatment.ObjectivesTo report a complex clinical case of a DID patient initially misdiagnosed as BPD.MethodsClinical case report.ResultsA 45-year-old Caucasian woman with a history of childhood intrafamilial sexual abuse and domestic violence, substance use disorder, autolesionistic and suicidal behaviour with an active diagnosis of BPD presented to our ambulatory mental health care service. A more thorough examination revealed a history of emotional and affect dysregulation, depersonalization, amnesia, intrusive traumatic memories and nightmares with affective, cognitive, and sensorimotor aspects, persistent negative Self-perception. Auditory verbal hallucinations were also present described as inner space with commentary and derogatory nature with one of them being a child voice. The diagnosis of tertiary structural dissociation and DID was finally made when three Apparently Normal Personalities emerged with several Emotional Personalities, authorising for cautious partial pharmacological washout and initiation of three phase-orientated treatment approach.ConclusionsDID is more common than is assumed and the overlap of core symptoms with other disorders can lead to a misdiagnosis. A careful clinical interview and evaluation of symptoms is mandatory to a correct DID diagnosis with a consequent appropriate therapy.DisclosureNo significant relationships.

The Sense of Self Over Time: Assessing Diachronicity in Dissociative Identity Disorder, Psychosis and Healthy Comparison Groups.

Dissociative experiences have been associated with diachronic disunity. Yet, this work is in its infancy. Dissociative identity disorder (DID) is characterized by different identity states reporting their own relatively continuous sense of self. The degree to which patients in dissociative identity states experience diachronic unity (i.e., sense of self over time) has not been empirically explored. This study examined the degree to which patients in dissociative identity states experienced diachronic unity. Participants were DID adults (n=14) assessed in adult and child identity states, adults with a psychotic illness (n=19), adults from the general population (n=55), children from the general population (n=26) and adults imagining themselves as children (n=23). They completed the Diachronic Disunity Scale (DDS), the Dissociative Experiences Scale (DES), and the Self-Concept Clarity Scale (SCCS). Diachronic disunity was not limited to psychiatric groups, but evident to some degree in all adult and child samples. The DID adult sample experienced more dissociation and self-confusion than the psychosis and adult comparison groups, but did not differ on the diachronic measure. DID patients in their child identity states and child comparisons showed disunity and were significantly different from child simulators, who showed relatively more unity. Results suggest that DID patients in either adult or child dissociative identity states, like those in other samples, do not universally experience themselves as having a consistent sense of self over time.

A Meta-Analysis of Hippocampal and Amygdala Volumes in Patients Diagnosed With Dissociative Identity Disorder

ABSTRACT Dissociative Identity Disorder (DID), an illness characterized by multiple personality states, has long been a controversial diagnosis within the psychiatric community. Demonstrating a neuroanatomical basis for the disorder may help to resolve the controversy. Current literature on the neuroanatomy associated with DID has focused on the hippocampus and amygdala and are inconclusive. This meta-analysis pools the results from n = 3 studies to compare the mean size of these two structures between DID patients, non-DID patients, and healthy controls. Patients diagnosed with both DID & PTSD were found to have smaller hippocampi bilaterally (p< .001) compared to healthy controls; no significant difference was seen in the amygdala. When comparing DID to PTSD patients, the left hippocampus was smaller (p< .001), with a trend for a smaller right hippocampus (p = .06). A comparison of the amygdala was not possible due to a lack of data. These findings suggest that a smaller hippocampus is seen in DID patients beyond what is seen for PTSD, provides neuroanatomical evidence for the memory impairment often seen in DID patients (i.e., amnesia experienced by the host and alters), and presents a potentially novel means to understand this disorder.

The utility of the Structured Inventory of Malingered Symptomatology for distinguishing individuals with Dissociative Identity Disorder (DID) from DID simulators and healthy controls

ABSTRACT Background: Individuals with dissociative identity disorder (DID) have complex symptoms consistent with severe traumatic reactions. Clinicians and forensic assessors are challenged by distinguishing symptom exaggeration and feigning from genuine symptoms among these individuals. This task may be aided by administering validity measures. Objective: This study aimed to document how individuals with DID score on the Structured Inventory of Malingered Symptomatology (SIMS). The second objective was to compare coached DID simulators and healthy controls to DID patients on the SIMS’s total score and subscales. The third objective was to examine the utility rates of the SIMS in distinguishing simulated DID from clinically diagnosed DID. Method: We compared SIMS data gathered from participants from two Dutch sites, one Swiss site and one U.S. site. Sixty-three DID patients were compared to 77 coached DID simulators and 64 healthy controls on the SIMS. A multivariate analysis compared the groups on the SIMS total scores and subscales, and post-hoc Games Howell tests and univariate ANOVAs examined differences between the groups. Utility statistics assessed the accuracy of the SIMS in distinguishing clinical from simulated DID. Results: DID simulators scored significantly higher than DID individuals and healthy controls on every SIMS subscale as well as the total score. The majority (85.7%) of the individuals with DID scored above the cut-off, which is typically interpreted as indicative of possible symptom exaggeration. DID individuals scored higher than the healthy controls on every subscale except Low Intelligence, even after controlling for dissociation. The subscales and items most frequently endorsed by the DID group are consistent with symptoms associated with complex trauma exposure and dissociative reactions. The SIMS total score had a sensitivity of 96% but an unacceptably low specificity of 14%. Conclusions: The findings indicate that the instrument is not accurate in assessing potential symptom exaggeration or feigning in DID.

Partition Weighted Approach For Estimating the Marginal Posterior Density With Applications

The computation of marginal posterior density in Bayesian analysis is essential in that it can provide complete information about parameters of interest. Furthermore, the marginal posterior density can be used for computing Bayes factors, posterior model probabilities, and diagnostic measures. The conditional marginal density estimator (CMDE) is theoretically the best for marginal density estimation but requires the closed-form expression of the conditional posterior density, which is often not available in many applications. We develop the partition weighted marginal density estimator (PWMDE) to realize the CMDE. This unbiased estimator requires only a single Markov chain Monte Carlo output from the joint posterior distribution and the known unnormalized posterior density. The theoretical properties and various applications of the PWMDE are examined in detail. The PWMDE method is also extended to the estimation of conditional posterior densities. We carry out simulation studies to investigate the empirical performance of the PWMDE and further demonstrate the desirable features of the proposed method with two real data sets from a study of dissociative identity disorder patients and a prostate cancer study, respectively. Supplementary materials for this article are available online.

Transfer of episodic self-referential memory across amnesic identities in dissociative identity disorder using the Autobiographical Implicit Association Test.

Individuals with dissociative identity disorder (DID) often report having no access to autobiographical experiences encoded by other identities. This research used the autobiographical Implicit Association Test (aIAT) to determine whether there was transfer of episodic self-referential memory events across amnesic identities. Nineteen DID individuals, 16 DID simulators, and 41 comparison participants (divided into amnesic and nonamnesic groups) engaged with an audio vignette of embarrassing scenarios to produce the experience of episodic self-referential events. Results showed transfer of episodic self-referential memory using the aIAT across identities that reported no conscious awareness of encoded content in DID. These aIAT results in DID patients were similar to the nonamnesic comparison group and the simulator group, and differed from the amnestic comparison group. These results are in line with previous literature showing transfer of memories, but extends this work to episodic self-referential memory. (PsycINFO Database Record (c) 2018 APA, all rights reserved).

Approach to the Development of Mind and Persona

To access medical specialists by health specialists working in the regional health field, the possibility of utilizing the voice approach for dissociative identity disorder (DID) patients as a health assessment for medical access (HAMA) was investigated. The first step is to investigate whether the plural personae in a single DID patient can be discriminated by voice analysis. Voices of DID patients including these with different personae were extracted from YouTube and were analysed using the software PRAAT with basic frequency, oral factors, chin factors and tongue factors. In addition, RAKUGO story teller voices made artificially and dramatically were analysed in the same manner. Quantitive and qualitative analysis method were carried out and nested logistic regression and a nested generalized linear model was developed. The voice from different personae in one DID patient could be visually and easily distinquished using basic frequency curve, cluster analysis and factor analysis. In the canonical analysis, only Roy's maximum root was <0.01. In the nested generalized linear model, the model using a standard deviation (SD) indicator fit best and some other possibilities are shown here. In DID patients, the short transition time among plural personae could guide to the risky situation such as suicide. So if the voice approach can show the time threshold of changes between the different personae, it would be useful as an Access Assessment in the form of a simple HAMA.

Alter Personalities in Dissociative Identity Disorder: Artefacts or Authentic Entities? Re-Evaluating the Available Evidence

An enduring debate has undoubtedly existed with respect to the legitimacy of Dissociative Identity Disorder (DID). While some contend that authentic dissociative experiences are supported by strong associations with a history of childhood abuse, others argue that the purported dissociative experiences are identity enactments sustained and reinforced by states of extreme suggestibility and fantasy proneness. However, the combination of theoretical speculation and empirical findings has thus far failed to provide unequivocal evidence for the existence of alters as either metaphors for different emotional states or truly autonomous entities that are capable of willful action. This article reviews the available evidence from a number of investigations examining the memory performance, behavioral manifestations, and physiological profiles of alters in DID. It concludes that neither memory studies nor psychobiological studies have delivered compelling evidence that alters of DID patients exist in a factual sense. It moreover demonstrates that some studies have suffered from methodological weaknesses, while findings from the overall body of literature are open to multiple interpretations. As such, they do not refute an interpretation of alters in terms of metaphors for disparate affective states. Recommendations for future studies aiming to investigate the phenomenon of alter are discussed.

Revisiting the etiological aspects of dissociative identity disorder: a biopsychosocial perspective.

Dissociative identity disorder (DID) is a chronic post-traumatic disorder where developmentally stressful events in childhood, including abuse, emotional neglect, disturbed attachment, and boundary violations are central and typical etiological factors. Familial, societal, and cultural factors may give rise to the trauma and/or they may influence the expression of DID. Memory and the construction of self-identity are cognitive processes that appear markedly and centrally disrupted in DID and are related to its etiology. Enduring decoupling of psychological modes may create separate senses of self, and metamemory processes may be involved in interidentity amnesia. Neurobiological differences have been demonstrated between dissociative identities within patients with DID and between patients with DID and controls. Given the current evidence, DID as a diagnostic entity cannot be explained as a phenomenon created by iatrogenic influences, suggestibility, malingering, or social role-taking. On the contrary, DID is an empirically robust chronic psychiatric disorder based on neurobiological, cognitive, and interpersonal non-integration as a response to unbearable stress. While current evidence is sufficient to firmly establish this etiological stance, given the wide opportunities for innovative research, the disorder is still understudied. Comparison of well-selected samples of DID patients with non-dissociative subjects who have other psychiatric disorders would further delineate the neurobiological and cognitive features of the disorder, whereas genetic research on DID would further illuminate the interaction of the individual with environmental stress. As such, DID may be seen as an exemplary disease model of the biopsychosocial paradigm in psychiatry.

The Neuropsychiatry of Dissociative Identity Disorder: Why many DID Patients Switch Personalities and Forget about the Previous Personality while under the Influence of one Personality?

Little has been known about the possible brain changes in the patients suffering from the psychiatric illness called Dissociative Identity Disorder (DID). This review suggests that the patients of DID have structural changes in the limbic system–hippocampus and amygdala -and the cortex. Blood flow is also altered in the orbito-frontal cortex. Another interesting finding of this review is that the glutamate release is found to be the cause of the dissociative symptoms. Furthermore, this review also highlights that in some DID patients the dorsolateral prefrontal and parietal cortex are activated. The limbic system especially the amygdala and the dorsolateral prefrontal and parietal cortex are associated with the short term and working memory, while the hippocampus is associated with long-term memory. All of these regions are somehow affected in the DID patient’s brain. Thus, this explains the symptoms of the multiple personality changes and forgetting about the previous personality. However, the future studies will broaden our knowledge about the complete neuropsychiatry of this unique medical illness.

Trauma-related self-defining memories and future goals in Dissociative Identity Disorder

This study examined the content of self-defining autobiographical memories in different identities in patients with Dissociative Identity Disorder (DID) and comparison groups of patients with PTSD, healthy controls, and DID simulators. Consistent with the DID trauma model, analyses of objective ratings showed that DID patients in trauma identities retrieved more negative and trauma-related self-defining memories than DID patients in avoidant identities. Inconsistent with the DID trauma model, DID patients’ self-rated trauma-relatedness of self-defining memories and future life goals did not differ between trauma identities and trauma avoidant identities. That is, the DID patients did not seem to be “shut off” from their trauma while in their avoidant identity. Furthermore, DID patients in both identities reported a higher proportion of avoidance goals compared to PTSD patients, with the latter group scoring comparably to healthy controls. The simulators behaved according to the instructions to respond differently in each identity (i.e., to report memories and goals consistent with the identity tested). The discrepant task behavior by DID patients and simulators indicated that DID patients did not seem to intentionally produce the hypothesized differences in performance between identities. In conclusion, for patients with DID (i.e., in both identities) and patients with PTSD, trauma played a central role in the retrieval of self-defining memories and in the formulation of life goals.

Adapting Dialectical Behavior Therapy for the Treatment of Dissociative Identity Disorder

Dialectical Behavior Therapy (DBT), created by Marsha Linehan, has been shown to be an effective therapy for the treatment of borderline personality disorder (BPD) and for suicidal and self-harming behavior. Dissociative identity disorder (DID) is a complex post-traumatic disorder which is highly comorbid with BPD, shares a number of clinical features with BPD, and which like BPD features a high degree of suicidality. The DID treatment literature emphasizes the importance of a staged approach, beginning with the creation of a safe therapeutic frame prior to addressing traumatic material; DBT is also a staged treatment, in which behavioral and safety issues are addressed in Stage 1, and trauma work reserved for Stage 2. The authors describe adapting DBT, and especially its techniques for Stage 1 safety work, for work with DID patients. Basic theoretical principles are described and illustrated with a case example.