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At least 19 recordsLinked to original sources
PubMed2006

Becoming one person: living with dissociative identity disorder.

Dissociative identity disorder is a rare diagnosis, although people currently with a diagnosis of psychosis may in fact be experiencing what is associated with the disorder. This article is co-authored by a nurse and a person who has lived with alters (multiple personalities) for nearly all of her life. Because of the rarity of the diagnosis, there is much misunderstanding and ignorance among lay people and mental health professionals. This article therefore clarifies historical and contemporary issues surrounding this particular mental health problem both through examining the literature and through narrative of the person's experience. Special attention is given to the reality of coping with the difficulties that dissociative identity disorder create.

Adaptation, Psychological↗
PubMed1999

An overview of the psychotherapy of dissociative identity disorder.

Dissociative Identity Disorder (DID) is identified and studied with increasing frequency. However, the controversy that often surrounds DID can make it difficult to approach its treatment in a circumspect manner. This paper will provide an overview of DID treatment as it is practiced by those experienced and skilled in the treatment of this group of patients. The treatment of DID resembles the treatment of other traumatized populations in that it is stage-oriented, beginning with supportive and strengthening work. Various stances toward the treatment of DID are reviewed, and specific issues that arise in the psychotherapy of DID are addressed, such as pragmatic arrangements, informed consent, work with alters, and the use of specific techniques, such as hypnosis. The employment of therapeutic modalities and ancillary therapies is discussed. The heterogeneity of DID patients is reviewed, and the characteristics of three general groups of DID patients, high, intermediate, and low in both function and prognosis, are explored. Considerations in the matching of DID patients to either exploratory or supportive treatments are discussed, and observations are made about both trauma work and the supportive psychotherapy of DID.

Adaptation, Psychological↗
PubMed1994

Distinguishing between multiple personality disorder (dissociative identity disorder) and schizophrenia using the Structured Clinical Interview for DSM-IV Dissociative Disorders.

The authors describe the systematic assessment of dissociative symptoms using the Structured Clinical Interview for DSM-IV Dissociative Disorders (SCID-D) in 50 psychiatric outpatients with a referring DSM-III-R diagnosis of either schizophrenia or schizoaffective disorder (N = 31) and subjects with multiple personality disorder (MPD [DSM-IV name change: dissociative identity disorder]; N = 19). Results indicate that patients with MPD experience significantly higher scores for five specific dissociative symptoms than patients with schizophrenia or schizoaffective disorder. The range, severity, and nature of the five dissociative symptom areas evaluated by the SCID-D distinguish MPD from the occasional occurrence of dissociative symptoms which may be seen in schizophrenia. Systematic assessment of dissociative symptoms using the SCID-D can assist in accurate differential diagnosis of MPD and schizophrenia.

Adult↗
PubMed1996

Intellectual functioning of inpatients with dissociative identity disorder and dissociative disorder not otherwise specified. Cognitive and neuropsychological aspects.

The intellectual functioning of 105 inpatients with multiple personality disorder and dissociative disorder not otherwise specified was assessed using the Wechsler Adult Intelligence Scale-Revised as part of a comprehensive research protocol. There were no significant intellectual differences between the groups on any major intelligence quotient summary score or any of the age-adjusted empirical factor scores. The anecdotal but widely accepted hypotheses that dissociative patients either have above average premorbid intelligence or that their current intellectual functioning is deleteriously affected by their fluctuant psychiatric disorder were not supported in this sample. A significant subsample of the multiple personality disorder group manifested abnormal interest scatter on the Wechsler Adult Intelligence Scale-Revised verbal subtests, and this variability was attributed to subtle neuropsychological deficits on the Memory/Distractibility factor. We speculate that dissociative patients might need to be evaluated for attention deficit disorder in addition to the range of dissociative symptoms in a comprehensive evaluation.

Adult↗
PubMedDate not supplied

The wreathing protocol: the imbrication of hypnosis and EMDR in the treatment of dissociative identity disorder and other dissociative responses. Eye Movement Desensitization Reprocessing.

Dissociative Identity Disorder (DID), a chronic childhood onset posttraumatic stress disorder, is currently recognized as a treatable condition. It is considered the paradigmatic dissociative condition and carries with it extreme posttraumatic symptomatology. Therapists skilled in the treatment of DID are typically fluent in the uses of hypnosis for stabilization, affect management, building a safe place and grounding to name of few. EMDR, which has come to the forefront of clinical awareness in the last ten years, seems aptly suited for the treatment of trauma, but can be destabilizing. This paper proposes a protocol, called Wreathing Protocol, for the imbricated use of EMDR and hypnosis in the treatment of not only DID (though this will be the primary focus of the paper), but also Dissociative Disorder Not Otherwise Specified (DDNOS) and chronic Posttraumatic Stress Disorder (PTSD). This protocol is useful to advanced clinicians skilled in both modalities independently. The sequential steps of the Wreathing Protocol will be described and illustrated by a clinical vignette on DID. The clinical implications of the use of the Wreathing Protocol will be discussed in DID as well as the chronic post traumatic spectrum.

Adult↗
PubMed2000

The differential diagnosis of epilepsy, pseudoseizures, dissociative identity disorder, and dissociative disorder not otherwise specified.

The authors review the co-occurrences of dissociative symptoms and disorders with epilepsy and pseudo-seizures and examine newer diagnostic instruments that assist in accurate diagnosis of persons with concomitant seizure behaviors and dissociative symptoms. They also review seizure behaviors and electroencephalographic findings in persons with dissociative identity disorder (DID) and dissociative disorder not otherwise specified (DDNOS) and dissociative symptoms in persons with epilepsy and with pseudoseizures. Dissociative symptoms in 15 patients with epilepsy and 15 with pseudo-seizures were examined using the Dissociative Experiences Scale (DES) and the Structured Clinical Interview for DSM-IV Dissociative Disorders (SCID-D). On the SCID-D, pseudo-seizure patients had significantly higher dissociative symptom scores than epileptic patients, but DES scores did not reliably distinguish epileptic and pseudo-seizure patients. Misdiagnosis of persons with seizures and dissociative symptoms can be avoided by careful adherence to DSM dissociative disorder criteria, the use of video-EEG monitoring, and systematic assessment of dissociative symptoms with the SCID-D.

Adult↗
PubMed1999

The tactical-integration model for the treatment of dissociative identity disorder and allied dissociative disorders.

The ebb and flow of the diagnosis of Dissociative Identity Disorder (DID) and other dissociative conditions has led to the evolution of theories and treatment modalities to resolve the fluctuating and ephemerous symptoms of these conditions. This paper summarizes the structured cognitive-behavioral-based treatment of dissociative disorders that will foster not only symptom relief but also an integration of the personalities and/or ego states into one mainstream of consciousness. This model of DID therapy is called the tactical integration model; it promotes proficiency over posttraumatic and dissociative symptoms, is collaborative and exploratory, and conveys a consistent message of empowerment to the patient.

Dissociative Identity Disorder↗
PubMed2005

Transfer of newly acquired stimulus valence between identities in dissociative identity disorder (DID).

Patients with Dissociative Identity Disorder (DID) frequently report episodes of interidentity amnesia, that is amnesia for events experienced by other identities. The goal of the present experiment was to test the implicit transfer of trauma-related information between identities in DID. We hypothesized that whereas declarative information may transfer from one identity to another, the emotional connotation of the memory may be dissociated, especially in the case of negative, trauma-related emotional valence. An evaluative conditioning procedure was combined with an affective priming procedure, both performed by different identities. In the evaluative conditioning procedure, previously neutral stimuli come to refer to a negative or positive connotation. The affective priming procedure was used to test the transfer of this acquired valence to an identity reporting interidentity amnesia. Results indicated activation of stimulus valence in the affective priming task, that is transfer of emotional material between identities.

Amnesia↗
PubMed2004

The persistence of folly: critical examination of dissociative identity disorder. Part II. The defence and decline of multiple personality or dissociative identity disorder.

In this second part of our review, we continue to explore the illogical nature of the arguments offered to support the concept of dissociative identity disorder (DID). We also examine the harm done to patients by DID proponents' diagnostic and treatment methods. It is shown that these practices reify the alters and thereby iatrogenically encourage patients to behave as if they have multiple selves. We next examine the factors that make impossible a reliable diagnosis of DID--for example, the unsatisfactory, vague, and elastic definition of "alter personality." Because the diagnosis is unreliable, we believe that US and Canadian courts cannot responsibly accept testimony in favour of DID. Finally, we conclude with a guess about the condition's status over the next 10 years.

Diagnosis, Differential↗
PubMed1998

ECT in dissociative identity disorder and comorbid depression.

Dissociative identity disorder (DID), previously named multiple personality disorder, is a diagnosis often complicated by comorbid major depression. We report on four cases of DID associated with severe self-destructive behavior and comorbid major depression treated with electroconvulsive therapy (ECT). In three of the patients, ECT appeared to be helpful in treating the comorbid depression without adversely affecting the DID. The potential risks of using ECT in patients with DID are reviewed.

Adult↗
PubMed2002

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.).

Adult↗
PubMedDate not supplied

[Study of dissociative disorders and depersonalization in a sample of young adult French population].

UNLABELLED: Questioned by several researches about dissociative disorders, the authors study differences established on the nosographic register, through a quantitative study and a psychodynamic argumentation in a sample of french population. From the utilisation of the Dissociative Experiences Scale (DES) created by Bernstein E and Putnam FW (1986), which is an excellent screening tool for dissociative disorders and constructed on DSM II diagnostic criterions, the authors will show the interest of a psychodynamic analysis of dissociative disorders, in the face of the diagnostic difficulty in relation to several approaches of this concept. This difficulty is studied giving the background to dissociative disorders and depersonalization. Ionescu (1999) shows that between 1890 and 1910 dissociation represents one of major themes of psychology, psychopathology and psychiatry. Then, this interest about dissociation decreases and will be almost non-existent in the middle of the twentieth century. The interest for dissociative disorder will grow in the eighties with north-american studies about multiple personality disorders. Until 1980, dissociative disorders exist in DSM II as a list of symptoms included into hysterical neurosis, among the conversive disorders. In 1980, the publication of DSM III replaces the notion of hysteria with the notion of dissociative disorder. In this way, we can see on the one hand somatoform disorders quarterly corresponding to the ancient version of conversive hysteria, and on the other hand dissociative disorders characterized by a perturbation of consciousness, memory, identity or perception of environment. In 1994, The DSM IV delete the notion of hysteria and neurosis and keeps only the notion of dissociative disorders. They include now the five following categories: dissociative amnesia, dissociative fugue, depersonalization disorder, dissociative identity disorder, dissociative disorder not otherwise specified (including derealization). Depersonalization disorders consist of "persistent or recurrent episodes of depersonalization characterized by a feeling of detachment or estrangement from one's self. The individual may feel like an automation or like he or she is living in a dream or movie" (DSM IV). Depersonalization disorder cannot be diagnosed if it is part of schizophrenia, panic disorder, acute stress disorder or dissociative identity disorder. Various depressive disorders, hypocondriasis or obsessive-compulsive disorders can accompany depersonalization disorder. The first purpose of this study will search the frequency of dissociative disorders and depersonalization in a sample of normal population. Further, the inclusion of depersonalization amongst dissociative disorders seems not so evident: depersonalization belongs to self-consciousness disorder in french psychiatry. This fact seems more logical insofar as dissociative disorders have all together a memory and consciousness perturbation, and this perturbation is missing from depersonalization's feeling. The second purpose will be to clarify and specify the particularity of depersonalization among dissociative diorders, from the psychopathological point of view. METHODOLOGY: The sample (n = 248) is made up of french young adults aged 17 to 30 (mean age = 20, SD = 15 and 24% is male population). Subjects were streamming from universities. The screening tool which was used is the Dissociative Experiences Scale, a 28-item patient questionnaire regarding various dissociative symptoms. The subject is asked to indicate the percentage of time, to the nearest 5%, that particular symptom is experienced. The score is made by adding the various percentages and finding a mean that is expressed in numbers from 0 to 100. Normal scores are in the range of 5 to 15 in american adults. RESULTS: The utilization of principal component analysis (PCA) with varimax rotation is justified by the will to compare this study with American's studies. The mean score obtained is 17.44%, and 13.3% of the scores exceed a psychiatric threshold at 30%. The descriptive analysis shows that the component 1 (PCA without varimax rotation) represents 33.02% of total explained variance. This result demonstrates that the structure of the DES is based on one concept, the same as the american population, it is the concept of dissociation. The Principal Component Analysis with varimax rotation of the DES ratings yielded a tree-factor solution: imaginative absorption (F1), depersonalization-derealization (F2) and dissociative amnesia (F3). Mean score for each factor is respectively: F1 = 21.56%, F2 = 13.95%, F3 = 11.04%. DES reliability was studied through computation of Cronbach's coefficient (0.92). The PCA with varimax rotation brings to the fore a full dissociative disorder without any trouble of memory and consciousness. This fact questions again once more the link between hysteria and dissociative disorders. There is here a clinical distinction between depersonalization-derealization and other dissociative disorders. Indeed, the absence of significant alteration of memory and conscience is specific of depersonalization and derealization in this study. CONCLUSION: Finally, this study concurs with DSM IV dissociative criterions. At last, one factor of PCA is composed by the association of depersonalization and derealization, in contradiction with DSM IV definition. This result shows that, into the french population, we cannot divide the two concepts.

Adult↗
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↗
PubMed1998

Apparent amnesia on experimental memory tests in dissociative identity disorder: an exploratory study.

Dissociative identity disorder (DID; called multiple personality disorder in DSMIII-R) is a psychiatric condition in which two or more identity states recurrently take control of the person's behavior. A characteristic feature of DID is the occurrence of apparently severe amnestic symptoms. This paper is concerned with experimental research of memory function in DID and focuses on between-identity transfer of newly learned neutral material. Previous studies on this subject are reviewed and a pilot study with four subjects is described. This study is specifically concerned with the question whether self-reported asymmetries in between-identity transfer can be replicated on experimental memory tests. A secondary aim was to examine whether, in the absence of explicit transfer, implicit transfer of information would occur. The results showed that the apparent amnestic asymmetry for explicit information was substantiated in the laboratory, although at least some leakage was present between the apparently amnestic identities. No evidence was found for better performance on implicit than on explicit memory tests in the apparently amnestic identities. In the discussion, parallels between apparent amnesia in DID and state-dependent memory are drawn, and the question of simulated amnesia is addressed.

Adult↗
PubMed1997

Objective documentation of child abuse and dissociation in 12 murderers with dissociative identity disorder.

OBJECTIVE: The skepticism regarding the existence of dissociative identity disorder as well as the abuse that engenders it persists for lack of objective documentation. This is doubly so for the disorder in murderers because of issues of suspected malingering. This article presents objective verification of both dissociative symptoms and severe abuse during childhood in a series of adult murderers with dissociative identity disorder. METHOD: This study consisted of a review of the clinical records of 11 men and one woman with DSM-IV-defined dissociative identity disorder who had committed murder. Data were gathered from medical, psychiatric, social service, school, military, and prison records and from records of interviews with subjects' family members and others. Handwriting samples were also examined. Data were analyzed qualitatively. RESULTS: Signs and symptoms of dissociative identity disorder in childhood and adulthood were corroborated independently and from several sources in all 12 cases; objective evidence of severe abuse was obtained in 11 cases. The subjects had amnesia for most of the abuse and underreported it. Marked changes in writing style and/or signatures were documented in 10 cases. CONCLUSIONS: This study establishes, once and for all, the linkage between early severe abuse and dissociative identity disorder. Further, the data demonstrate that the disorder can be distinguished from malingering and from other disorders. The study shows that it is possible, with great effort, to obtain objective evidence of both the symptoms of dissociative identity disorder and the abuse that engenders it.

Adult↗
PubMed1996

Lifetime axis I and II comorbidity and childhood trauma history in dissociative identity disorder.

According to DSM-IV, dissociative identity disorder is characterized by the existence within the person of two or more distinctly different identities or personality states that from time to time take executive control of the person's body and behavior, with accompanying amnesia (American Psychiatric Association, 1994). By retrospective patient report, dissociative identity disorder usually occurs in conjunction with severe childhood trauma (Kluft 1985; Putnam et al. 1986; Ross 1989; Ross et al. 1989a, 1990a). The disorder appears to be the most severe form of disturbance on the dissociative disorders continuum (Boon and Draijer 1993; Coons 1992; Ross 1985; Ross et al. 1992). There is evidence that dissociative identity disorder may be more prevalent than once believed in the general population (Ross 1991) and among general adult psychiatric inpatients (Latz et al. 1995; Ross et al. 1991; Saxe et al. 1993).

Adult↗
PubMed2002

Malingering dissociative identity disorder: objective and projective assessment.

Verification of dissociative identity disorder presents challenges given the complex nature of the illness. This study addressed the concern that this disorder can be successfully malingered on objective and projective psychological tests. 50 undergraduate women were assigned to a Malingering or a Control condition, then completed the Rorschach Inkblot Test and the Dissociative Experiences Scale II. The Malingering group were asked to simulate dissociative identity disorder; controls received instructions to answer all materials honestly. Analysis indicated that malingerers were significantly more likely to endorse dissociative experiences on the Dissociative Experiences Scale II in the range common to patients with diagnosed dissociative identity disorder. However, on the Rorschach there were no significant differences between the two groups. Results suggest that the assessment of dissociative identity disorder requires a multifaceted approach with both objective and projective assessment tools. Research is needed to assess these issues in clinical populations.

Adolescent↗