Multidimensional Inventory Of Dissociation Research Articles

Schneiderian First Rank Symptoms Significantly Predict a Dissociative Disorder Diagnosis in Psychiatric In-Patients

ABSTRACT Previous empirical studies on the relationship between psychotic symptoms and dissociative disorders focused on auditory hallucinations only or employed limited statistical analyses. We investigated whether the frequency of Schneiderian first rank symptoms (FRS) predicts the presence or absence of a dissociative disorder (DD). Psychiatric in-patients (n = 116) completed measures of dissociation, FRS and general psychological distress (GPD). DD diagnoses were confirmed by multidisciplinary teams or administering the Structured Clinical Interview for DSM-IV Dissociative Disorders-Revised (SCID-D-R). The FRS were recorded in the Multidimensional Inventory of Dissociation (MID) and a mean score obtained for 35 relevant items: Voices arguing, voices commenting, made feelings, made impulses, made actions, influences on body, thought withdrawal, and thought insertion. A global severity index (GSI) of GPD was obtained from the Symptom Checklist–90–Revised (SCL-90-R). Logistic regression models examined whether FRS predict diagnostic classification of patients under a DD (n = 16) or not (n = 100), controlling for GSI. The overall fit of the model was significant (p = .0002). DD was correctly classified using frequency of FRS, controlling for GSI. The latter was moderately associated with FRS (r = 0.56). FRS more than doubled the odds of a DD diagnosis (odds = 2.089; 95% CI = 1.409–3.098; correct classification rate 87.1%). The study provides convincing evidence that FRS are closely related to DDs. FRS should alert clinicians to consider DDs in differential diagnosis of psychiatric in-patients. Future research should analyze whether FRS also predict a diagnosis of schizophrenia or other psychiatric disorders.

Efficacy of dialectical behavior therapy-A in adolescents with dissociative disorder in India: An open-label trial

Introduction: Dialectical behavior therapy-A (DBT-A) is a comprehensive, evidence-based treatment for children and adolescents. To date, there is no empirically validated research for adolescents diagnosed with dissociative disorder (DD) which implies the efficacy of DBT-A. Methods: This was a hospital-based, prospective, open-label trial based on purposive sampling. It was conducted on 40 adolescents diagnosed with DD. They were divided into study group (N = 20) and treatment-as-usual (TAU; N = 20). The TAU group did not receive any psychotherapy apart from medications, but in the study group, they received pharmacotherapy along with DBT-A module (20 sessions). Multidimensional Inventory of Dissociation and Cognitive Emotion Regulation Questionnaire were used as outcome measures before and after the intervention and compared between the two groups. Results: Findings suggested improvement in the spectrum of dissociative symptoms and cognitive emotion regulations (maladaptive) in sample over 8 weeks at the postassessment phase. However, the outcome measures did not reflect significant improvement in the case of adaptive emotion regulation skills at the post-tests. Further, analyses suggested a mild-to-moderate effect size in terms of therapeutic efficacy in the study group compared to TAU. Conclusion: DBT-A intervention module is an effective addition to the management of adolescents diagnosed with DD.

Anxiety sensitivity predicts depression severity in individuals with dissociative identity disorder

BackgroundAnxiety sensitivity involves the fear of anxiety-related symptoms and can exacerbate both major depressive disorder and posttraumatic stress disorder (PTSD) symptoms. However, it is unclear if anxiety sensitivity plays a similar role in dissociative identity disorder (DID) where symptoms of depression and PTSD commonly co-occur. We examined the association between anxiety sensitivity, depression, PTSD and dissociative symptoms in DID, hypothesizing a positive association between all symptoms and anxiety sensitivity. MethodParticipants were 21 treatment-seeking adult females with histories of childhood trauma, current PTSD, and DID. Participants completed the Anxiety Sensitivity Index (ASI), Beck Depression Inventory-II, Childhood Trauma Questionnaire, Multidimensional Inventory of Dissociation, and PTSD Checklist for DSM-5. The ASI included subscales that assessed anxiety sensitivity in cognitive, physical, and social domains. ResultsParticipants reported high levels of anxiety sensitivity. A multiple regression analysis demonstrated that the ASI cognitive subscale was the strongest predictor of depressive symptoms. No direct associations were identified between anxiety sensitivity and PTSD or dissociative symptoms. We conducted a mediation analysis to test an indirect relationship between cognitive anxiety sensitivity and dissociative symptoms, and found a significant indirect effect through depressive symptoms. ConclusionsOur results suggest that cognitive anxiety sensitivity or the fear of cognitive dyscontrol is linked with symptom severity in DID. These findings emphasize the need to assess for and utilize interventions that target anxiety sensitivity, which may in turn alleviate symptoms of depression and dissociation in DID.

The Multidimensional Inventory of Dissociation (MID) in Depersonalization Disorder: General Findings with a Clinical Emphasis on Memory and Identity Disturbances

ABSTRACT The Multidimensional Inventory of Dissociation (MID) was administered to 23 participants diagnosed with DSM-IV-TR Depersonalization Disorder (DDD) by structured interview. The MID has not been previously examined in DDD and does not generate a diagnostic formula for the disorder. Mean MID score for the sample was modestly elevated at 18.54, and was significantly correlated with Dissociative Experiences Scale, Cambridge Depersonalization Scale, and Childhood Trauma Questionnaire scores. Criterion A (General Dissociation) Depersonalization and Depersonalization scale scores were markedly elevated (41.70 and 40.98 respectively), followed by moderate elevations in the Identity Confusion (36.01), Trance (25.44), and Memory Problems (23.30) scales. Criterion B (Intrusions from partly dissociated self-states) mean score was modestly elevated (19.13) and declined to 13.67 once items overlapping with the Depersonalization and Identity Confusion scales were excluded. Criterion C (fully dissociated manifestations of other self-states) mean score was minimally elevated (6.57). Of the 168 pathological dissociation items, 55 were clinically elevated in DDD. Closer examination of the Intrusions and Amnesia items that were modestly elevated in DDD revealed that these items did not reflect the presence of alters, but rather represented known depersonalization-related phenomena. We propose a preliminary formula, based on cutoff scores for Criterion A Depersonalization and/or Derealization, Criterion B, and Criterion C (≥20, ≤28, ≤11) for the sensitive diagnosis of DDD (82.6% of participants), which would require future investigation for replication and determination of specificity vis-à-vis the other dissociative disorders.

Large-Scale Functional Brain Network Architecture Changes Associated With Trauma-Related Dissociation

Dissociative experiences commonly occur in response to trauma, and while their presence strongly affects treatment approaches in posttraumatic spectrum disorders, their etiology remains poorly understood and their phenomenology incompletely characterized. Methods to reliably assess the severity of dissociation symptoms, without relying solely on self-report, would have tremendous clinical utility. Brain-based measures have the potential to augment symptom reports, although it remains unclear whether brain-based measures of dissociation are sufficiently sensitive and robust to enable individual-level estimation of dissociation severity based on brain function. The authors sought to test the robustness and sensitivity of a brain-based measure of dissociation severity. An intrinsic network connectivity analysis was applied to functional MRI scans obtained from 65 women with histories of childhood abuse and current posttraumatic stress disorder (PTSD). The authors tested for continuous measures of trauma-related dissociation using the Multidimensional Inventory of Dissociation. Connectivity estimates were derived with a novel machine learning technique using individually defined homologous functional regions for each participant. The models achieved moderate ability to estimate dissociation, after controlling for childhood trauma and PTSD severity. Connections that contributed the most to the estimation mainly involved the default mode and frontoparietal control networks. By contrast, all models performed at chance levels when using a conventional group-based network parcellation. Trauma-related dissociative symptoms, distinct from PTSD and childhood trauma, can be estimated on the basis of network connectivity. Furthermore, between-network brain connectivity may provide an unbiased estimate of symptom severity, paving the way for more objective, clinically useful biomarkers of dissociation and advancing our understanding of its neural mechanisms.

Measuring Dissociative Symptoms and Experiences in an Australian College Sample Using a Short Version of the Multidimensional Inventory of Dissociation

ABSTRACT This paper investigated a 60-item version of the Multidimensional Inventory of Dissociation (MID) with the potential to capture the full range of dissociative symptoms that characterize each of the dissociative disorders (DD). The 28-item Dissociative Experiences Scale (DES) was designed to capture a wide range of dissociative phenomena, but college population studies indicate it may not be adept at identifying the full range of dissociative symptoms and disorders. The 218-item MID has the advantage of capturing the full range of dissociative symptoms and has diagnostic capabilities for all DSM-5 DD, but the disadvantage of taking considerably longer than the DES to complete. Using university students and staff (N = 313), this paper investigated a 60-item version of the MID with the potential to capture the full range of dissociative symptoms that characterize each of the DD. Results indicate the MID-60 has a nearly identical factor structure to the full MID, excellent internal reliability, and content and convergent validity. Using the MID-60, at least 8% of participants at an Australian university were positive for a DD and, on average, participants self-reported having dissociative experiences 13% of the time. The present study’s findings suggest the MID-60 is a promising alternative to the DES, with results about the prevalence of DDs and dissociative experiences consistent with those found using clinical interviews and the DES.

Efficacy of adjunctive Dialectical Behavior Therapy Skills in Childhood and Adolescent Dissociative Disorders: An open-label pilot study

Background: Dissociative disorder is very common among children and adolescents. Dissociation is primarily caused by a stress reaction. Stressful situations can worsen symptoms and cause problems with functioning in everyday activities. Early identification and therapeutic intervention appear to be particularly efficacious in children in contrast to adults. Aim: The current open-label pilot study aimed to examine the efficacy of adjunctive Dialectical Behaviour Therapy (DBT) skills in improving dissociative symptoms along with other psychopathology- depression, anxiety, coping, impulsivity and emotion dysregulation in adolescents with Dissociative disorders. Methods: This was a hospital-based pilot, open-label trial based on purposive sampling. The study consisted of five adolescents aged between 12 to 17 years of age. Three were female, and two were male. Mini-International Neuropsychiatric Interview for Children and Adolescents, Standard progressive matrices, Multidimensional Inventory of Dissociation, Barratt Impulsiveness Scale Version 11, Hamilton Anxiety Rating Scale, Childhood Depression Inventory, Cognitive Emotion Regulation Questionnaire, and Adolescent-Coping Orientation for Problem Experiences were administered as outcome measures. Participants received the DBT skills training module individually for eight weeks. Pre-post measurements were taken, and data was analysed using SPSS. Results: Findings suggested a significant improvement in overall dissociative symptoms over a period of eight weeks of DBT skills therapy. There was also a significant improvement in depressive symptoms, anxiety, impulsivity, coping, and emotion regulation high effect size over the eight weeks of the study period. Conclusion: DBT skills module for Adolescents was found to be effective therapeutic management for dissociative disorder. Results indicate viable resources and pathways for future development are suggested.

Assessing Voice Hearing in Trauma Spectrum Disorders: A Comparison of Two Measures and a Review of the Literature.

Voice hearing (VH) can occur in trauma spectrum disorders (TSD) such as posttraumatic stress disorder (PTSD) and dissociative disorders. However, previous estimates of VH among individuals with TSD vary widely. In this study, we sought to better characterize the rate and phenomenology of VH in a sample of 70 women with TSD related to childhood abuse who were receiving care in a specialized trauma program. We compared the rate of VH within our sample using two different measures: 1) the auditory hallucination (AH) item in the Structured Clinical Interview for DSM-IV-TR (SCID), and 2) the thirteen questions involving VH in the Multidimensional Inventory of Dissociation (MID), a self-report questionnaire that comprehensively assesses pathological dissociation. We found that 45.7% of our sample met threshold for SCID AH, while 91.4% met criteria for MID VH. Receiver operating characteristics (ROC) analyses showed that while SCID AH and MID VH items have greater than chance agreement, the strength of agreement is only moderate, suggesting that SCID and MID VH items measure related but not identical constructs. Thirty-two patients met criteria for both SCID AH and at least one MID VH item (“unequivocal VH”), 32 for at least one MID VH item but not SCID AH (“ambiguous VH”), and 6 met criteria for neither (“unequivocal non-VH”). Relative to the ambiguous VH group, the unequivocal VH group had higher dissociation scores for child voices, and higher mean frequencies for child voices and Schneiderian voices. Our findings suggest that VH in women with TSD related to childhood abuse is common, but that the rate of VH depends on how the question is asked. We review prior studies examining AH and/or VH in TSD, focusing on the measures used to ascertain these experiences, and conclude that our two estimates are consistent with previous studies that used comparable instruments and patient samples. Our results add to growing evidence that VH—an experience typically considered psychotic or psychotic-like—is not equivalent to having a psychotic disorder. Instruments that assess VH apart from psychotic disorders and that capture their multidimensional nature may improve identification of VH, especially among patients with non-psychotic disorders.

Assessing Trauma-Related Dissociation in Forensic Contexts: Addressing Trauma-Related Dissociation as a Forensic Psychologist, Part II

Chronic dissociative reactions and dissociative disorders can occur following traumatic events and are associated with suffering and impaired functioning. Therefore, trauma-related dissociation could be part of the claims made in civil actions or contribute to mitigation or an insanity defense in criminal actions. Dissociative reactions to trauma, including dissociative disorders, are more common than most mental health professionals realize. Unfortunately, few professionals have training in the assessment of dissociation, and forensic experts may be unaware of research indicating that standard interpretations of well-regarded assessment instruments can result in inaccurate determinations of symptom exaggeration in cases with dissociation. This paper is the second paper of a two-part series that aims to expand assessors’ knowledge about trauma-related dissociation (TRD) and enhance their ability to assess and present information about dissociation. In this article, we focus on the forensic assessment of TRD and discuss: dissociative symptoms; complex trauma; trauma-related disorders; an approach to assessment of TRD; trauma-related reactions that can impede the detection of TRD; and differential diagnosis of genuine versus feigned dissociation. In addition, we review research related to the validity and appropriate interpretation of the following measures in use with persons with TRD: Dissociative Experiences Scale, Multiscale Dissociation Inventory, Somatoform Dissociation Questionnaire, Trauma Symptom Inventory-2, Multidimensional Inventory of Dissociation, Structured Clinical Interview for Dissociative Disorders-Revised, Minnesota Multiphasic Personality Inventory-2, Personality Assessment Inventory, Structured Interview of Reported Symptoms, Test of Memory Malingering, and the Gudjonsson Suggestibility Scale.

Comparing the symptoms and mechanisms of “dissociation” in dissociative identity disorder and borderline personality disorder

ABSTRACTA total of 75 patients were diagnosed with the Structured Clinical Interview for DSM–IV Dissociative Disorders–Revised as having dissociative identity disorder (DID), and 100 patients were diagnosed with the Structured Interview for DSM–IV Personality as having borderline personality disorder (BPD). Both groups were administered the Multidimensional Inventory of Dissociation (MID). DID patients had significantly higher MID scores than BPD patients, different distributions of MID scores, and different MID subscale profiles in 3 ranges of MID scores (0–15, 15–30, 30–45). The core MID symptoms—exhibited at all ranges of MID scores—for DID patients (the presence of alters, identity confusion, and memory problems) and BPD patients (flashbacks, identity confusion, and memory problems) were ostensibly similar but were considered to be mostly produced by different underlying processes. Multiple regression analyses showed that the core MID symptoms of DID patients had different predictors than did the core MID symptoms of BPD patients. Alter identities seemed to generate most—but not all—dissociative phenomena in DID patients, whereas only the 24% highest scoring BPD patients (MID ≥45) seemed to manifest alter-driven dissociative experiences. Most BPD dissociative experiences appeared to be due to 5 other mechanisms: (a) BPD-specific, stress-driven, rapid shifts of self-state; (b and c) nondefensive disruptions of the framework of perceptual organization with or without an accompanying BPD-specific, dissociation-like disintegration of affective/neurocognitive functioning; (d) a defensive distancing or detachment from distress (i.e., simple depersonalization); and (e) Allen, Console, and Lewis’s (1999) severe absorptive detachment.

Three Dimensions of Dissociative Amnesia

Principal axis factor analysis with promax rotation extracted 3 factors from the 42 memory and amnesia items of the Multidimensional Inventory of Dissociation (MID) database (N = 2,569): Discovering Dissociated Actions, Lapses of Recent Memory and Skills, and Gaps in Remote Memory. The 3 factors' shared variance ranged from 36% to 64%. Construed as scales, the 3 factor scales had Cronbach's alpha coefficients of .96, .94, and .93, respectively. The scales correlated strongly with mean Dissociative Experiences Scale scores, mean MID scores, and total scores on the Structured Clinical Interview for DSM–IV Dissociative Disorders–Revised (SCID-D-R). What is interesting is that the 3 amnesia factors exhibited a range of correlations with SCID-D-R Amnesia scores (.52, .63, and .70, respectively), suggesting that the SCID-D-R Amnesia score emphasizes gaps in remote memory over amnesias related to dissociative identity disorder. The 3 amnesia factor scales exhibited a clinically meaningful pattern of significant differences among dissociative identity disorder, dissociative disorder not otherwise specified–1, dissociative amnesia, depersonalization disorder, and nonclinical participants. The 3 amnesia factors may have greater clinical utility for frontline clinicians than (a) amnesia as discussed in the context of the Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition, nosology of the dissociative disorders or (b) P. Janet's (1893/1977) 4-fold classification of dissociative amnesia. The author recommends systematic study of the phenomenological differences within specific dissociative symptoms and their differential relationship to specific dissociative disorders.

Dissociation and Psychosis in Dissociative Identity Disorder and Schizophrenia

Dissociative symptoms, first-rank symptoms of schizophrenia, and delusions were assessed in 40 schizophrenia patients and 40 dissociative identity disorder (DID) patients with the Multidimensional Inventory of Dissociation (MID). Schizophrenia patients were diagnosed with the Structured Clinical Interview for the DSM–IV Axis I Disorders; DID patients were diagnosed with the Structured Clinical Interview for DSM–IV Dissociative Disorders–Revised. DID patients obtained significantly (a) higher dissociation scores; (b) higher passive-influence scores (first-rank symptoms); and (c) higher scores on scales that measure child voices, angry voices, persecutory voices, voices arguing, and voices commenting. Schizophrenia patients obtained significantly higher delusion scores than did DID patients. What is odd is that the dissociation scores of schizophrenia patients were unrelated to their reports of childhood maltreatment. Multiple regression analyses indicated that 81% of the variance in DID patients’ dissociation scores was predicted by the MID's Ego-Alien Experiences Scale, whereas 92% of the variance in schizophrenia patients’ dissociation scores was predicted by the MID's Voices Scale. We propose that schizophrenia patients’ responses to the MID do not index the same pathology as do the responses of DID patients. We argue that neither phenomenological definitions of dissociation nor the current generation of dissociation instruments (which are uniformly phenomenological in nature) can distinguish between the dissociative phenomena of DID and what we suspect are just the dissociation-like phenomena of schizophrenia.

Are Major Dissociative Disorders Characterized by a Qualitatively Different Kind of Dissociation?

A total of 66 patients with a major dissociative disorder, 54 patients with nondissociative disorders, and 30 nonclinical controls were administered the Structured Clinical Interview for DSM–IV Dissociative Disorders–Revised, the Dissociative Experiences Scale, the Multidimensional Inventory of Dissociation, and the Symptom Checklist 90–Revised. Dissociative patients reported significantly more dissociative and nondissociative symptoms than did nondissociative patients and nonclinical controls. When general psychopathology was controlled, the dissociation scores of dissociative patients were still significantly higher than those of both other groups, whereas the dissociation scores of nondissociative patients and nonclinical controls no longer differed. These findings appear to be congruent with a typological model of dissociation that distinguishes between 2 qualitatively different kinds of dissociation. Specifically, the results of this study suggest that the dissociation that occurs in major dissociative disorders (i.e., dissociative identity disorder [DID] and dissociative disorder not otherwise specified, Type 1 [DDNOS-1]) is qualitatively different from the dissociation that occurs in persons who do not have a dissociative disorder. In contrast to previous research, the dissociation of persons who do not have a dissociative disorder is not limited to absorption; it covers a much wider range of phenomena. The authors hypothesize that different mechanisms produce the dissociation of persons with DID and DDNOS-1 as opposed to the dissociation of persons who do not have a dissociative disorder.

Dissociation in Borderline Personality Disorder: A Detailed Look

The objective of the present study was to assess in detail the whole spectrum of normal and pathological dissociative experiences and dissociative disorder (DD) diagnoses in borderline personality disorder (BPD) as diagnosed with the Revised Diagnostic Interview for Borderlines. Dissociation was measured comprehensively in 21 BPD outpatients using the Structured Clinical Interview for DSM–IV Dissociative Disorders–Revised, the Multidimensional Inventory of Dissociation (MID), the Dissociative Experiences Scale pathological taxon analysis, and the Somatoform Dissociation Questionnaire. The frequencies of DDs in this BPD sample were as follows: 24% no DD, 29% mild DD (dissociative amnesia and depersonalization disorder), 24% DD Not Otherwise Specified (DDNOS), and 24% dissociative identity disorder. With regard to the dissociative experiences endorsed, almost all patients reported identity confusion, unexplained mood changes, and depersonalization. Even those BPD patients with mild DD reported derealization, depersonalization, and dissociative amnesia. BPD patients with DDNOS reported frequent depersonalization, frequent amnesia, and notable experiences of identity alteration. BPD patients with dissociative identity disorder endorsed severe dissociative symptoms in all categories. Analysis of the MID pathological dissociation items revealed that 32% of the items were endorsed at a clinically significant level of frequency by more than 50% of our BPD patients. In conclusion, the frequencies of Diagnostic and Statistical Manual of Mental Disorders (4th ed.) DDs in these patients with BPD were surprisingly high. Likewise, the “average” BPD patient endorsed a wide variety of recurrent pathological dissociative symptoms.

Assessing Dissociative Symptoms and Dissociative Disorders in College Students in the Philippines

This study is part of a larger project (Gingrich, 2004) that examined dissociation in a student sample in the Philippines. High and low-moderate dissociators were identified from a sample of 459 freshman university students based on cutoff scores on two brief screening instruments. The Multidimensional Inventory of Dissociation (MID) and Structured Clinical Interview for DSM-IV Dissociative Disorders (SCID-D) were then used to determine if any of the participants met diagnostic criteria for dissociative identity disorder (DID) or other dissociative disorders (DDs). Comparisons were made between the frequency of specific DDs diagnosed by each instrument and an evaluation done of the usefulness of the MID and SCID-D as diagnostic tools in a Filipino student sample.

The Multidimensional Inventory of Dissociation (MID): A Comprehensive Measure of Pathological Dissociation

ABSTRACT This article describes the development and validation of the Multidimensional Inventory of Dissociation (MID). The MID is a 218-item, self-administered, multiscale instrument that comprehensively assesses the phenomenological domain of pathological dissociation and diagnoses the dissociative disorders. The MID measures 14 major facets of pathological dissociation; it has 23 dissociation diagnostic scales that simultaneously operationalize (1) the subjective/ phenomenological domain of pathological dissociation and (2) the hypothesized dissociative symptoms of dissociative identity disorder (Dell, 2001a). The MID was designed for clinical research and for diagnostic assessment of patients who present with a mixture of dissociative, posttraumatic, and borderline symptoms. The MID demonstrated internal reliability, temporal stability, convergent validity, discriminant validity, and construct validity. The MID also exhibited incremental validity over the Dissociative Experiences Scale (DES) by predicting an additional 18% of the variance in weighted abuse scores on the Traumatic Experiences Questionnaire (TEQ). Confirmatory factor analysis (CFA) did not support a one-factor model of the MID's clinical scales (i.e., the 14 facets and the 23 diagnostic symptoms). In contrast, however, CFA of the MID's factor scales (Dell & Lawson, 2005) has strongly supported a one-factor model. It was concluded that both the MID's 168 dissociation items and the construct of pathological dissociation have a second-order, unifactorial structure.

Development of the Hebrew-Multidimensional Inventory of Dissociation (H-MID): A Valid and Reliable Measure of Pathological Dissociation

ABSTRACT The Multidimensional Inventory of Dissociation (MID; Dell, 2004b) has 168 dissociation items and 50 validity items. The MID assesses 14 major facets of dissociation, 23 symptoms of dissociation, and has 5 validity scales. The MID operationalizes (a) the subjective/phenomenological domain of dissociation, and (b) 23 hypothesized symptoms of dissociative identity disorder (DID). This article describes the development of a Hebrew version of the MID (H-MID). In a sample of clinical and nonclinical research participants, the H-MID had strong internal consistency, temporal stability, and strong structural, convergent, discriminant, and construct validity. In addition, mean H-MID scores demonstrated incremental validity over the Hebrew Dissociative Experiences Scale (H-DES) by predicting an additional 17% of the variance in weighted trauma scores on the Traumatic Experiences Questionnaire (TEQ). Factor analysis of the H-MID extracted a single factor: dissociation. Both the MID and the subjective/phenomenological concept of pathological dissociation appear to have applicability not only in North America, but also in a heterogeneous Middle Eastern culture.

Dissociative phenomenology of dissociative identity disorder.

The goal of this study was to investigate the dissociative phenomenology of dissociative identity disorder (DID). The Multidimensional Inventory of Dissociation (MID) was administered to 34 patients with DID, 23 patients with dissociative disorder not otherwise specified (DDNOS), 52 patients with mixed psychiatric disorders, and 58 normal individuals. DID patients obtained significantly higher scores than the other three groups on 27 dissociation-related variables. DDNOS patients had significantly higher scores than normals and mixed psychiatric patients on 17 and 15 dissociation-related variables, respectively. The findings of the present study are virtually identical to a large body of replicated findings about the dissociative phenomenology of DID. This broad range of dissociation-related phenomena, which routinely occurs in individuals with DID, is largely absent from the DSM-IV-TR account of DID. Factor analysis of the 11 dimensions of dissociation that are measured by the MID extracted only one factor that accounted for 85% of the variance. It was concluded that dissociation is a unifactorial taxon or natural type that has different aspects or epiphenomena (i.e., amnesia, depersonalization, voices, trance, etc.).