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PubMed1995

Autobiographical memory across personalities in dissociative identity disorder: a case report.

A core feature of dissociative identity disorder (DID) is the amnesia that exists between personalities. This study investigated autobiographical memory in a patient, HS, prior to and after her diagnosis with DID. This diagnosis was associated with increased recall of traumatic memories that were reported by a child personality. The child personality was able to recognize only half of the memories reported by the host personality. HS's responses were dissimilar to responses of control and nonexperiment participants. These findings suggest that DID is associated with alterations in autobiographical memory and that memories differ across personalities. Results are discussed in terms of memory and pseudomemory development in DID.

Adult↗
PubMed2003

Interidentity amnesia for neutral, episodic information in dissociative identity disorder.

Interidentity amnesia is considered a hallmark of dissociative identity disorder (DID) in clinical practice. In this study, objective methods of testing episodic memory transfer between identities were used. Tests of both recall (interference paradigm) and recognition were used. A sample of 31 DID patients was included. Additionally, 50 control subjects participated, half functioning as normal controls and the other half simulating interidentity amnesia. Twenty-one patients subjectively reported complete one-way amnesia for the learning episode. However, objectively, neither recall nor recognition scores of patients were different from those of normal controls. It is suggested that clinical models of amnesia in DID may be specified to exclude episodic memory impairments for emotionally neutral material.

Adult↗
PubMed1998

Effectiveness of treatment for dissociative identity disorder.

In a recent study by Ellason and Ross, patients with Dissociative Identity Disorder reported a decrease in symptoms on the Millon Clinical Multiaxial Inventory-II over a 2-yr. follow-up period. Patients judged to have achieved integration of their personalities rated themselves as more substantially improved on the Millon-II than did patients judged not to have achieved integration. Ellason and Ross suggested that this improvement reflected the influence of treatment; however, for several reasons, their findings are open to alternative interpretations. First, in the absence of proper control conditions, one cannot rule out the contribution of other factors to the over-all improvement of patients such as regression of symptoms toward the mean following the initial assessment. Second, patients self-reported improvement was less substantial when data were reanalyzed using more appropriate statistical criteria. Third, the greater improvement observed among integrated patients relative to nonintegrated patients may reflect influences other than differential responsiveness to treatment, such as less severe pathology prior to treatment. More systematic research is needed to clarify the effect of treatment on Dissociative Identity Disorder.

Defense Mechanisms↗
PubMed2002

Psychiatric admission in a general hospital. Patients profile and patterns of service utilization over a decade.

OBJECTIVE: To analyze the socio-demographic and clinical characteristics of admitted patients and the patterns of their service utilization over a decade from March 1988 to March 1998. METHODS: Prospective data compilation using a structured questionnaire, hospital records and follow-up observations at King Fahd Hospital of the University in Al-Khobar, Kingdom of Saudi Arabia. RESULTS: A total of 1366 patients (683 of each sex) had 2217 admissions in 10 years. By the International Classification of Diseases, 10th edition criteria, 19.5% had schizophrenia, 15.2% bipolar disorder, 9.9% depressive episodes, 8.6% acute and transient psychotic disorders, 7.7% adjustment disorders and 7.6% dissociative disorders. Males were more frequently admitted for schizophrenia and females for mood and anxiety disorders. Most non-Arab expatriates were diagnosed as acute and transient psychotic, stress-related or dissociative disorders. Re-hospitalizations constituted 28% of all admissions. The mean length of stay was 25 days per admission and 41 days per patient. The overall bed occupancy rate was 84.9%. A subgroup of 16.9% of patients, mostly with schizophrenia or bipolar disorder, consumed 62.3% of the bed occupancy. CONCLUSION: Gender and immigration were the main determinants of variance in patient characteristics, nosological distribution and pattern of service use. More beds are needed. Psycho-educational programs should be intensified to reduce the social stigma and societal intolerance to mental patients. Active family involvement improves compliance and might reduce re-hospitalization rates. Heavy service consumers should be transferred to long-stay facilities.

Adolescent↗
PubMed2006

Hippocampal and amygdalar volumes in dissociative identity disorder.

OBJECTIVE: Smaller hippocampal volume has been reported in several stress-related psychiatric disorders, including posttraumatic stress disorder (PTSD), borderline personality disorder with early abuse, and depression with early abuse. Patients with borderline personality disorder and early abuse have also been found to have smaller amygdalar volume. The authors examined hippocampal and amygdalar volumes in patients with dissociative identity disorder, a disorder that has been associated with a history of severe childhood trauma. METHOD: The authors used magnetic resonance imaging to measure the volumes of the hippocampus and amygdala in 15 female patients with dissociative identity disorder and 23 female subjects without dissociative identity disorder or any other psychiatric disorder. The volumetric measurements for the two groups were compared. RESULTS: Hippocampal volume was 19.2% smaller and amygdalar volume was 31.6% smaller in the patients with dissociative identity disorder, compared to the healthy subjects. The ratio of hippocampal volume to amygdalar volume was significantly different between groups. CONCLUSIONS: The findings are consistent with the presence of smaller hippocampal and amygdalar volumes in patients with dissociative identity disorder, compared with healthy subjects.

Adult↗
PubMed1995

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

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

Adult↗
PubMed1998

Psychometric characteristics of the somatoform dissociation questionnaire: a replication study.

BACKGROUND: The present study aimed to replicate the results of previous studies concerning the development of two versions of the Somatoform Dissociation Questionnaire. The SDQ-20 evaluates the severity of somatoform dissociative phenomena, and the SDQ-5 is a dissociative disorders screening instrument. METHODS: Thirty-one patients with dissociative disorders and 45 consecutive psychiatric outpatients with other DSM-IV diagnoses completed the SDQ-20 and SDQ-5 as well as the Dissociation Questionnaire which measures psychological dissociation. RESULTS: Mokken scale analysis showed that the items of the SDQ-20 are strongly scalable on a latent unidimensional scale. Internal consistency was high. The SDQ-20 convergent validity was supported by high intercorrelations with the DIS-Q. Dissociative patients obtained significantly higher scores than comparison patients. Patients with dissociative identity disorder scored significantly higher compared to patients with dissociative disorder nos. Sensitivity (94%) and specificity (98%) of the SDQ-5 were very satisfactory, as were, at an estimated prevalence rate of dissociative disorders of 10% among psychiatric patients, positive predictive value (84%) and negative predictive value (99%). CONCLUSIONS: All results replicated the first findings, and therefore corroborate the conclusion that the SDQ-20 and SDQ-5 are instruments of sound psychometric quality, and that somatoform dissociative phenomena are core symptoms of complex dissociative disorders.

Adolescent↗
PubMed2004

Dissociative identity disorder associated with mania and change in handedness.

OBJECTIVE: To investigate the overlap between dissociative and bipolar disorders with reference to their neurophysiological foundations. BACKGROUND: Case reports of anomalous lateralization and shifts in handedness associated with both affective and dissociative conditions have intermittently surfaced in the literature. The two disorders are, however, usually considered to be distinct psychopathological entities. METHOD: A case of co-occurring bipolar disorder and dissociative identity disorder (DID) is presented. RESULTS: The "switch" in personality coincided with manic or hypomanic symptoms and was associated with a change in handedness. CONCLUSIONS: A parallel between the "personality" shifts that characterize DID and the mood fluctuations that underlie bipolar disorder is drawn, suggesting some nosological overlap between the two disorders. The possibility that these two psychiatric conditions share a similar neurophysiological architecture is also raised.

Adolescent↗
PubMed2006

Identity state-dependent attentional bias for facial threat in dissociative identity disorder.

Biased attention for threatening stimuli has been associated with many forms of psychopathology. Attention to threatening faces presented below perceptual thresholds was assessed in patients diagnosed with dissociative identity disorder using a pictorial emotional Stroop task. Patients were tested in two different identity states, in one of which they claimed strong awareness of trauma. Attentional bias for social threat proved state-dependent in the patients and deviated from the patterns observed in controls.

Adult↗
PubMed2005

The effect of emotional context on cognitive inhibition and attentional processing in dissociative identity disorder.

In light of previous research, the current study tested the hypothesis that dissociative identity disorder (DID) would be characterised by effective cognitive inhibitory functioning when tested in a neutral context, but weakened inhibition when tested in an emotionally negative context. Using a negative priming task (i.e. the flanker task) to assess inhibitory ability 11 DID, 11 depressed, and 11 general population participants were tested in the two differing experimental contexts. The contexts were manipulated by instructions and word stimuli, and following the completion of this task participants completed the Dissociative Experiences Scale and the Schizotypal Personality Scale. DID participants displayed a greater degree of self-reported anxiety in the negative context and as expected displayed a reduction in inhibition in this context but not in the neutral context. The degree of negative priming for the depressed and general population samples remained stable across contexts as did their anxiety levels. The DID sample displayed slower response times to negative compared to neutral words but this attentional bias was not evident for the two comparison groups. The relationship between increased arousal, inhibitory functioning, dissociation and information processing in DID is discussed.

Adult↗
PubMed1984

The differential diagnosis of multiple personality. A comprehensive review.

This review offers guidelines for the diagnosis of multiple personality disorder and other dissociative disorders and presents diagnostic criteria for psychotic disorders, factitious disorders, affective disorders, anxiety disorders, psychosexual disorders, and others that may or may not coexist with multiple personalities.

Adult↗
PubMed2006

Inter-identity amnesia in dissociative identity disorder: a simulated memory impairment?

BACKGROUND: Although included in the current edition of the DSM, there does not seem to be consensus among mental health professionals regarding the diagnostic status and scientific validity of dissociative identity disorder (DID). This study was aimed at the detection of simulation of inter-identity amnesia in DID. METHOD: A sample of 22 DID patients was included, together with a matched control sample of subjects instructed to simulate inter-identity amnesia, a guessor group that had no knowledge of the stimulus material and a normal control group. A multiple-choice recognition test was included. The rate of incorrect answers was determined. Moreover, the specific simulation strategy used was examined by providing subjects with a range of choices that varied in extent of disagreement with the correct answer and determining whether plausible or implausible answer alternatives were selected. RESULTS: On the recognition test DID patients selected incorrect answers above chance like simulators. Patients thus seem to use their knowledge of the correct answer in determining their given answer. They were not characterized by a well-thought-out simulating behaviour style, as indicated by the differences in selection of specific answer alternatives found between patients and simulators. CONCLUSIONS: DID patients were found not to be characterized by an actual memory retrieval inability, in contrast to their subjective reports. Instead, it is suggested that DID may more accurately be considered a disorder characterized by meta-memory problems, holding incorrect beliefs about their own memory functioning.

Adult↗
PubMed2005

The Child Behavior Checklist as an indicator of posttraumatic stress disorder and dissociation in normative, psychiatric, and sexually abused children.

Expert ratings and confirmatory factor analyses were used to derive a posttraumatic stress disorder (PTSD), dissociation, and a combined PTSD/dissociation scale from the Child Behavior Checklist (CBCL). Validity was established by examining the relationship of these scales to features of sexual abuse thought to relate to severity and chronicity, as well as to self-report scales of PTSD and dissociation. In addition, this study examined differences between normative, psychiatric, and sexually abused children on the new scales. Both the sexual abuse and psychiatric sample differed significantly from the normative sample on all scales, but not from each other. Despite correlations of the dissociation and PTSD/dissociation combined scale with features of trauma and child self-report of PTSD and dissociation, the absence of differences between the clinical groups on the derived scales suggests that the scales measure generic, as opposed to trauma-related, distress.

Child↗
PubMed2001

A case of pain, factitious disorder and boundary violations.

Although health professionals are usually familiar with factitious disorders, evaluating such cases may be complicated, particularly in the legal arena. This article describes a patient who presented with pain complaints to numerous doctors. Eventually, a malpractice suit was brought against one of the patient's physicians who had diagnosed her condition as multiple personality disorder (dissociative identity disorder). Factitious disorder and the doctor's prescription of pain medications were issues raised during the trial. In view of the issue of harm, physicians' responsibilities and limitations during ongoing medical care are addressed in this case report.

Dissociative Identity Disorder↗
PubMed2000

Dissociative identity disorder: a literature review.

This paper presents a review of the literature into dissociative identity disorder. This disorder, previously known as multiple personality disorder, is increasingly diagnosed, in part because of more focused diagnostic tools, but also because people are accessing services to assist with the longterm problems of early child abuse and neglect. Dissociative identity disorder is examined in the literature according to a variety of discourses, each of which suggest different ways of conceptualizing problems and therapeutic approaches. These discourses reviewed include: psychiatry, psychology, corporeality, feminism, social constructivism, anthropology, and postmodernism. The paper concludes with an examination of the nursing literature and suggests opportunities for nursing research into this complex mental health problem.

Dissociative Identity Disorder↗
PubMed2006

[Identity and dissociation in cyberspace. A case of dissociative identity disorder associated with internet role playing].

OBJECTIVE: By mediating dissociative experiences, the Internet can challenge the boundaries of people's sense of identity. To illustrate this hypothesis, a case of dissociative identity disorder (DID) is presented. CLINICAL PICTURE: A young unemployed woman created and frequently played several characters in an online game. For more than 2 years she spent up to 12 h a day in the Internet, assuming various personalities, which in return intruded upon her neglected real life. TREATMENT AND OUTCOME: During the course of an inpatient psychotherapeutic treatment, the clinical diagnosis of DID was confirmed by psychometric testing. After 12 weeks of psychotherapy, the patient had managed to identify her fragmented identities as character traits and integrated them into her core personality. She rearranged her real everyday life, found a new job, and reduced her online activities. DISCUSSION: Even though the patient's psychopathology stems from a disposition in terms of a personality disorder with histrionic and narcissistic features, excessive internet role play obviously functioned as a trigger to develop DIS. Conclusively, cyberspace's anonymous interactivity may offer the possibility to explore one's identity while also putting at risk its coherence.

Adult↗