Treatment Of Dissociative Identity Disorder Research Articles

Advancing Research on and Treatment of Dissociative Identity Disorder With People With Lived Experience.

Dissociative identity disorder is a posttraumatic, psychobiological syndrome that develops over time during childhood. Despite empirical evidence supporting the validity of this diagnosis and its relation to trauma, the disorder remains a misunderstood and stigmatized condition. This article highlights expert consensus guidelines and current empirical research on the treatment of dissociative identity disorder. In addition, the authors describe the Lived Experience Advisory Panel (LEAP), which was designed to leverage the expertise of individuals with dissociative identity disorder to combat stigma and improve research, clinical programming, professional education, and public outreach related to the disorder. This article also describes how LEAP members have partnered with other researchers to create new knowledge through participatory action research in order to advance equitable service provision and effect positive change.

The treatment of dissociative identity disorder in an eating disorder residential treatment setting.

Child maltreatment, dissociation and dissociative disorders have been noted in relationship to eating disorders (EDs) for decades, and their co-occurrence generally is associated with greater morbidity, self-harm and mortality. The concomitant presentation of dissociative identity disorder (DID) with an ED (ED + DID) is especially challenging, and there is limited information on approaches to and the effects of integrated treatment for this serious comorbidity, especially in higher levels of care. There are also limited treatment resources for such patients, since they are often turned away from specialty units due to lack of expertise with or bias toward one or the other disorder. We report our experience with a case series of 18 patients with DSM-5 defined ED + DID (mean age (SD) = 32.6 (11.8) years) admitted to residential treatment (RT) and assessed using validated measures for symptoms of ED, major depression (MD), PTSD, state-trait anxiety, quality of life (QOL), age of ED onset, and family involvement during treatment. All patients received integrated, multimodal, trauma-focused approaches including those based on DID practice guidelines, principles of cognitive processing therapy (CPT), and other evidence-based approaches. Fifteen of 18 patients also completed discharge reassessments, which were compared to admission values using paired t-tests. Following integrated, trauma-focused RT, patients with ED + DID demonstrated statistically significant improvements in all measures, with medium (anxiety) to high (ED, PTSD, MD, QOL) effect sizes. These results provide positive proof of concept that patients with ED + DID can be effectively treated in a specialty, trauma-focused ED program at higher levels of care. EDs and dissociative identity disorder (DID) are related conditions, but little is known about treating patients with both conditions. We describe the clinical features and integrated treatment of 18 such patients, 15 of whom completed discharge assessments. Significant clinical improvements were found in multiple domains (ED, PTSD, mood, anxiety, quality of life), which demonstrate positive proof of concept that ED + DID can be effectively treated in a specialty, trauma-focused ED program.

See You on the Other Side: A Novel Exploring Dissociative Identity Disorder

Dissociative identity disorder (DID) is a disease in which people experience multiple separate personalities and function independently of one another and autonomously from one another. DID is a rare disease found in only 1.5% of people worldwide, so I want to find out what the cause of people having DID and how they recover from DID. The method that I will use is to create a creative work in the form of a novel. The story will involve family dysfunction and post-traumatic avoidance as the causes of DID and three approaches, which are safety and stability, work on traumatic memories, and re-integration into life, to weaken the DID effects. Narrative-wise, this creative fiction novel is set in 2022's America, where this story will highlight Ethan's daily life as the person that has DID, which creates a new identity, Elliot. The finding is that Ethan's DID effect cannot be cured, but it can be recovered with the help of Maydeline using the three approaches of DID treatment.

A Transtheoretical Model and Treatment of Dissociative Identity Disorder: A Case Report

Dissociative identity disorder is the most severe of the dissociative disorders and neither the trauma model nor the sociocognitive model provide a satisfactory account of its complexity. Transtheoretical models propose an interaction of traumatic experiences as well as cultural, cognitive, and social factors in the development of the disorder. This perspective has important implications for the treatment which should encompass a reprocessing of traumatic memories, emotional regulation skills, and a modification of dysfunctional beliefs about memory. An elaboration of dissociative identities should be prevented. A corresponding inpatient treatment approach is described.

Dissociative Identity Disorder in an Inpatient Setting

AbstractDespite recognition in current and past versions of DSM, dissociative identity disorder (DID) remains a controversial psychiatric disorder which hampers its diagnosis and treatment. Factors that lead misdiagnosing of DID are the unfamiliarity with spectrum of dissociative disorders, the existence of feigned DID, the reluctance of individuals with DID to present their dissociative symptoms, and lack of knowledge and appreciation of its epidemiology which is shown to have 1.5% lifetime prevalence. An accurate diagnosis allows the appropriate interventions leading to fewer hospitalizations.KC is 28 y.o. female with a psychiatric history significant for polysubstance use, PTSD, and GAD, who presented to the ED due concern for DID per mother. Prior to presentation, she had thrashed her mother’s home of which she denies recollection. She has a history of early sexual trauma by her own family. She screened 44 on the Dissociative Experiences Scale (DES). Throughout her hospitalization, she exhibited questionable lapses of disassociation, although there were no noted changes of posture, dress, speech, or acknowledgement of alters. She was discharged on Remeron 15 mg, Risperdal 2 mg, and Prazosin 2 mg with outpatient resources for trauma-based therapy.DID is characterized by two or more distinct identities or personality that coincide with fluctuating states of consciousness and changing access to autobiographical memory. The neurological similarities between personality states in DID and PTSD subtypes support a trauma-related etiology of DID. Although there are many interviewing tools, the DES has been the most widely used clinically. Although collateral information, detailed history, and DES were concerning for DID, observation did not show distinct dissociative episodes as discussed by collateral (alter described as destructive and cold towards her own infant) although the hospital environment may not have provided enough stress for patient to transition from one personality to another.The International Society for the Study of Trauma and Dissociation proposes a phase-oriented treatment approach: 1) establishing safety, stabilization, and symptom reduction; 2) confronting, working through and integrating traumatic memories; 3) identity integration and rehabilitation. From inpatient standpoint, phase 1 and 2 may be promptly addressed. Besides initiation of Remeron and Risperdal (consistent with treatment of DID in two prior case reports), implement grounding techniques and coping mechanisms against triggers for dissociative episodes. Inpatient screening can facilitate earlier accurate diagnosis, faster and more targeted interventions, prevent unnecessary direct and indirect societal costs, and, most importantly, improve quality of life for those with the disorder.FundingNo Funding

Cognitive and Creative Therapy with Emotional Reactions and Anxiety in the Primary Treatment of Dissociative Identity Disorder

Cognitive and Creative Therapy with Emotional Reactions and Anxiety in the Primary Treatment of Dissociative Identity Disorder

“Looking, Standing, Moving, Connecting, Thinking,” A Psychoanalytic Mantra Through the Lens of Dissociative Disorders: Commentary on David Levit’s “Somatic Experiencing”

ABSTRACT Responding to a deficit in the psychoanalytic literature on trauma treatment, David Levit contributes a way to interweave Somatic Experiencing (SE) with psychoanalysis in the treatment of highly traumatized and dissociative patients. I agree heartily with the need for interweaving and integration that Levit notes, but I add that other trauma/dissociation treatments, including treatment of dissociative identity disorder (DID), can be integrated as well. Especially for patients with dissociative disorders, dissociation-oriented treatments are appropriate. Finally, I describe how integrations of the type Levit proposes, including other trauma/dissociation modalities, if they are guided by psychoanalytic principles, can be properly considered psychoanalysis, and come under the rubric of “trauma-analysis.”

Did Philip Bromberg Know He Was Treating DID? Does It Matter?

Initially informed by concepts related to dissociative experience via the notion of Sullivan’s ‘not-me’ (1953), Philip Bromberg went on to craft a relational psychoanalysis built upon the foundation of a multiple self-state theory of mind that grew from his discussions with Stephen Mitchell and also from his attention to the literature and treatment of dissociative identity disorder (DID). Although he never claimed to be treating DID, the reader is invited to form their own opinion about the reach of Bromberg’s work. Additional concepts related to Bromberg’s perspectives, such as “relational traumatology” and the notion of the “participant-witness,” are briefly explored. Clinical vignettes illustrate these concepts.

Through the Lens of a DID Specialist

The case of Daniel, a patient with distinct dissociated self-states, is discussed from the perspective of a psychoanalyst with expertise in the treatment of Dissociative Identity Disorder. Early assessment of the patient’s dissociative mental structure is emphasized to inform and guide the treatment of profound early childhood trauma. Also discussed is developing and maintaining interpersonal relatedness not only between the patient and analyst but—importantly—between the dissociated internal self-states as well.

Case report of a dissociative identity disorder

IntroductionPatients with dissociative identity disorder (DID) present two or more identities, where one of them is the main one. Although it is a widely questioned diagnosis, it is currently found in the main DSM-5 and ICD-10 diagnostic manuals.ObjectivesPresent a case of dissociative identity disorder.Methods46-year-old woman who attended the CSM referred for her MAP due to anxiety-depressive symptoms. Throughout the interviews the patient brings up to 4 identities with alterations in memory, consciousness, multiple dissociative symptoms, sound thinking, constant fluctuations in mood. She is separated, has two children, takes care of them, although she is not able to maintain work functionality. The patient is seen once a week for 45 minutes. Psychotherapeutic treatment is carried out, the objective of which is to establish a safe therapist-patient bond to favor the integration of their parts, and pharmacological treatment, which was carried out with haloperidol, lorazepam and desvenlafaxine.ResultsThroughout sessions, the anxious symptoms diminished, being able to carry out psychotherapeutic work. Dissociative symptoms were slightly reduced, partially integrating some of the identities. There was a slight stabilization in mood and decrease in psychotic symptoms.ConclusionsThere is no well-established treatment for DID. Combined therapy (psychotherapy and pharmacological) may be an option for these patients. The therapeutic framing of the sessions, working the link, and the low-dose antipsychotic treatment were favorable.Keyworddissociative identity framing link

The concept of ego state: From historical background to future perspectives

IntroductionEgo state theory (EST) and therapy was developed by Watkins and Watkins, based on Federn who first proposed the concept of ego state. The Watkins state that EST is based on three pillars: psychoanalysis, hypnosis and Janet’s concept of dissociation. EST has been a major theory and therapy for the treatment of complex traumatization, in particular dissociative disorders, and is also a therapy helpful for other types of difficulties and pathologies. ObjectiveThis paper aims at clarifying the theoretical background of EST, as well as recent inputs from EST therapists, and how new concepts on trauma and dissociation challenged and influenced modern EST. Method and resultsAfter a thorough analysis of the literature, we provide with a detailed presentation of the main concepts of EST, their strengths and coherence, as well as the lack of coherence of some of these concepts. The development of EST stretches over several decades and attests to the richness of this integrative therapy and to the challenging development of the understanding of trauma and its sequalae. ConclusionEven if the theoretical foundation of EST is imperfect, EST has developed an integrative model of psychotherapy for traumatized individuals that is still valuable today. EST should be acknowledged for its great influence on modern psychotraumatology and on the treatment of dissociative identity disorder.

DID in resurgence, not retreat

SUMMARYContrary to the assertion of Paris, diverse indicators suggest that the diagnosis and treatment of dissociative identity disorder (DID) are resurgent rather than retreating. This commentary reviews the evidence that justifies the description of this condition as controversial, including research into dissociative amnesia. The potential harm that can result from a diagnosis of DID and risky treatment techniques, including hypnosis and abreaction, are described. It is suggested that this scientifically unproven and potentially harmful treatment model should be confronted and quelled and its diagnosis and treatment subjected to critical clinical review, including randomised controlled trials, as a matter of urgency. A plea is made for the Royal College of Psychiatrists to update its 1997 guidance document and for professional training to incorporate updated psychological and neurobiological research on human memory.DECLARATION OF INTERESTNone.

EMDR for Safe Desensitization of Memories and Fusion of Parts in DID. Conference Room Technique, Trauma Mapping and Management of Unplanned Abreactions

This paper explores the use of Eye Movement Desensitization and Reprocessing therapy (EMDR) in the treatment of Dissociative Identity Disorder (DID), in its most severe form. I discuss suggested modifications and applications for the safe use of EMDR, including the essential use of the conference room technique. I have described the concept of “trauma memory mapping” before EMDR is delivered. Additionally, this paper considers how parts may be created and the possible connections between parts within a trauma memory. Trauma memory desensitization, and the associated fusion of parts into the system, with the planned use of EMDR is described. Insights from the management of internal resistance to fusion are presented. A case example with safe management of an unplanned abreaction has been provided. A mention is given to the comparison of use between hypnosis facilitated abreaction and EMDR.

Attachment as a Second Language: Treating Active Dissociative Identity Disorder

Evidence is accumulating (Brand, Classen, McNary, & Zaveri, 2009, Brand, Loewenstein, & Spiegel, 2014; Brand et al., 2013; Brand et al., 2012; Dorahy et al., 2014) to show that by and large, Dissociative Identity Disorder (DID) is well amenable to psychotherapeutic intervention along the lines of the International Society for the Study of Trauma and Dissociation (ISSTD) Guidelines for treatment of DID in adults (ISSTD, 2011), based on the Three Phase Approach (Van der Hart, Nijenhuis, & Steele, 2006). In this paper, however, I would like to draw our attention to those cases where improvement is not reached, despite high-quality, dedicated therapeutic efforts. I refer particularly to patients with Active DID (Sachs, 2013c, 2017): patients who remain persistently victimized and apparently unable to establish even the most basic safety needed for the therapeutic process (“phase one” of the threephase approach). I suggest that the therapeutic problem in these cases may lie in mis-attunement (Stern, 1998) between the therapist’s and the patient’s attachment language; and that this mis-attunement is due to a uniquely disordered attachment-pattern which characterises people with Active DID. I thus propose that, in these cases, phase one needs to be substantially modified and focus on therapeutic attunement rather than on safety. “Attachment as a second language” is proposed for treating people with persistent (“Active”) DID, while considering the clinical, theoretical and practical aspects of this therapeutic approach.

Envisioning and Embodying Empowerment in Dissociative Identity Disorder: A Case Illustrating the TwoPart Film Technique

This paper describes and illustrates the Two-Part Film technique (TPF; Krakauer, 2006), an intervention characteristic of the Collective Heart model (CH; Krakauer, 2001), a phase-oriented approach to treating dissociative disorders highlighting the client’s access to inner guidance. A clinical case is presented to illustrate the central role of the TPF in transcendence of shame in the treatment of a young woman with polyfragmented Dissociative Identity Disorder (DID) reporting extensive incest and ritual abuse in childhood and adolescence. Assumptions are presented regarding the perpetuation of distorted posttraumatic beliefs and self-defeating behaviors—a common source of gridlock in the treatment of DID—and claims are articulated regarding the role of the TPF in helping the client obtain accurate information about her inherent value and her power to heal and thrive. The TPF procedure is described, with special attention to amplification and attenuation of affect and sensation, followed by a detailed case presentation featuring verbatim descriptions of the client’s experiences. Finally, the author’s rationale for developing the CH model and the TPF technique are elaborated, evaluations of the efficacy of the technique by the client and therapist (author) are presented, significant features of the TPF illustrated by the clinical case are highlighted, cautions regarding utilization of the model and technique are noted, and further development and empirical assessment of the approach are discussed.

The origin of so-called “shadowy personalities” in patients with dissociative identity disorder

IntroductionIn this study, the author presents ideas about what he calls “shadowy personalities” (SPs), that is, destructive and aggressive, often masterminding, parts of personality among patients with dissociative identity disorder (DID). ObjectiveThis study demonstrates how these SPs manifest themselves, how they can be dealt with in various clinical settings, and how this notion adds to the understanding and treatment of DID. MethodThe author seeks to conceptualize several types of SPs, which manifest themselves differently in various clinical settings. The review of literature demonstrates how this notion could be related to, and different from, notions such as “persecutory parts of the personality” and “controlling emotional part (EP of the personality)” proposed by past authors. Then, case material is presented, and the implications of some psychotherapeutic approaches are further discussed. ResultsSPs have been demonstrated to have the following features: anger/aggressiveness, difficulty in identification, temporary appearance in critical situations, and an almost physically felt presence. The author demonstrates some prototypical SPs, such as SPs with aggressors’ voices, depressive and self-destructive SPs, SPs asserting themselves on behalf of the host personality, and competitive SPs. A hypothesis of the way SPs are formed is presented, primarily based on Ferenczi's theory of identification with the aggressor (IWA). Three types of situations leading to IWA are proposed: 1. A child identifies with the aggressive aspect of the aggressor (i.e., “becoming” an aggressor); 2. A child identifies with the internal image of him/herself in the aggressor's mind (i.e., aggression is directed inward); and 3. A child identifies with a bystander (both in reality and fantasy) and aggression is used in support of him/herself. ConclusionThe notion of SPs describes not only their nature but also the way they are perceived by other parts of personality. It was found that SPs are formed through different types of IWA, but their clinical manifestation can be a mixture of features reflecting all of them. The notion of SPs is experience-near for patients and can be used as a communication resource for the therapeutic pair to better understand one another and focus on the therapeutic orientation and goals.

Catching a Wave: The Hypnosis-Sensitive Transference-Based Treatment of Dissociative Identity Disorder (DID)

In this article, I will describe the way in which I work with enactment-prone dissociative patients in the transference. This approach requires an appreciation of the phenomena of hypnosis and the auto-hypnotic aspects of some forms of dissociation. Essentially, I learn from the patient and my interactions with the patient how hypnotic phenomena and auto-hypnotic defenses manifest themselves in the therapeutic relationship in order both to understand them and ultimately to bring them under conscious control. Because of the fluidity and turbulence of these states, I use the analogy of catching a wave, in which timing and balance are essential, albeit elusive factors in effecting a successful treatment. The importance of having experience with many patients, attending conferences, seeking supervision, and undergoing one’s own therapy will be also discussed as important prerequisites for the clinician endeavoring to utilize this type of approach. This preparation, this quest for such a “balance,” is modeled after the so-called tripartite model of training employed in psychoanalytic training institutes. I will offer clinical material to illustrate this approach, which I have described as “psychoactive psychotherapy.” In such treatments, the clinician may be taken by surprise and is likely to be thrown “off balance” from time to time. The mutually shared understanding of such moments is essential to regaining clinical balance in the therapeutic setting, and can lead to if not create important turning points in the treatment process.

The Potential Relevance of Maladaptive Daydreaming in Treatment of Dissociative Identity Disorder in Persons With Ritual Abuse and Complex Inner Worlds

The literature on maladaptive daydreaming may be useful in case conceptualization and treatment planning in a subset of dissociative identity (DID) cases. These are DID cases with elaborate inner worlds, high numbers of “alter personalities,” and often histories of Satanic ritual abuse, or involvement in government mind control programs. I recommend that the therapist adopt a position of therapeutic neutrality with regard to the historical accuracy of such trauma memories. Consideration of the similarities and differences between maladaptive daydreaming and cases of DID with elaborate inner worlds may be helpful in managing counter-transference and in forming a treatment alliance with all sectors of the personality system.

Beyond the Impasse - Reflections on Dissociative Identity Disorder from a Freudian-Lacanian Perspective.

Dissociative identity disorder (DID) is a widely contested diagnosis. The dominant posttraumatic model (PTM) considers early life trauma to be the direct cause of the creation of alter identities and assumes that working directly with alter identities should be at the core of the therapeutic work. The socio-cognitive model, on the other hand, questions the validity of the DID diagnosis and proposes an iatrogenic origin of the disorder claiming that reigning therapeutic and socio-cultural discourses create and reify the problem. The author argues that looking at the underlying psychical dynamics can provide a way out of the debate on the veracity of the diagnosis. A structural conception of hysteria is presented to understand clinical and empirical observations on the prevalence, appearance and treatment of DID. On a more fundamental level, the concept of identification and the fundamental division of human psychic functioning are proposed as crucial for understanding the development and treatment of DID.

Treatment strategies for programming and ritual abuse

ABSTRACTIndividuals in treatment for dissociative identity disorder not uncommonly describe childhood involvement in organized, multi-perpetrator ritual abuse. They described being “programmed” by the perpetrators and feel that the programming is out of their control. The author has developed a set of treatment strategies and interventions for such cases. These are based on the principle of therapeutic neutrality and can be used no matter what assumptions the therapist makes about the historical accuracy of the memories and beliefs. In ritual abuse cases, there are commonly “cult alters” who express allegiance to and identification with the perpetrators, and who state the ideology of the cult as personal beliefs. Often, the host personality holds and expresses the opposite half of the ambivalent attachment to the perpetrators: the host takes the position of helpless, powerless victim of the cult alters and programming, and wants to be rescued and “deprogrammed” by the therapist. This is a victim–rescuer–perpetrator triangle re-enactment. The perpetrator introjects involved in the re-enactment can be engaged in the therapy, and can become allies in recovery and the process of integration. Techniques for accomplishing this are described.