7. Dissociative Identity Disorder & Culture Flashcards
Outline dissociative phenomena
Dissociation = disconnection or separation between psychological processes (feelings, thoughts, memories)
Depersonalization: experiences of unreality / detachment from one’s self
Derealisation: experiences of unreality or detachment from one’s surroundings
Dissociative amnesia: when you don’t have conncetions to memories that you should be able to remember
Dissociative fugue (amnesia and travel): where people travel long distances without knowing how
Outline Dissociative Identity Disorder (DID)
FKA: Multiple Personality Disorder
- presence of 2+ personality or identity states that recurrently take control over the body
- switches of executive control b/w different dissociated identities with varying degrees of amnesia b/w identities
What was the development of DID from MPD
DSM3: Recognition of MPD as a stand alone condition (existence of 2 or more distinct personalities)
DSM4: DID (the presence of 2 or more distinct identities or personality states - each with its own relatively enduring pattern of perceiving, relating to, and thinking about the environment)
Criteria for DID (DSM5)
A. disruption of identity characterised by 2 or more distinct personality states (may be described as an experience of possession) - involves marked discontinuity in sense of self and agency, alterations in affect, behaviour, consciousness, memory, perception, cognition functioning.
B. recurrent gaps in recall of everyday events, important personal information, traumatic events
C. symptoms cause clinically significant distress / impairment
D. disturbance is not a normal part of a broadly accepted cultural / religious practice
E. symptoms are not attributable to the physiological effects of a substance or medical condition
Prevalence of DID
12 month prevalence is 1.5%
F > M in clinical settings (males tend to deny symptoms)
Major depression co-occurence common
> 70% of DID attempt suicide, multiple attempts common, other self-injurious behaviour
Misdiagnosis with Bipolar disorder common
Outline the phenomenology of DID
Older language:
‘host personality’: the ‘person’ who presents for treatment, bears the legal name, suffers time loss and psychological complaints
alters or subpersonalities: childlike personalities, protectors, helpers-advisors, guardians, inner persecutors, deviant, avengers, defenders
Typical DID: 2-15 alters
Polygragmented DID: 100-1000 alters
What is a personality fragment
easily distinguishable from personalities because they lack a life history and a wide range of mood / affect
more easily integrated in therapy
What is dissociative amnesia (relevant to Criterion B)
- gaps in any aspect of autobiographical memory
- lapses in memory of recent events or well-learned skills
- discovery of possessions that the individual has no recollection of every owning
What are the 2 case histories of DID
Sybil: developed 16 personalities as a response to sustained childhood abuse from her schizophrenic mother
Billy Milligan: 24 different personalities
- severe childhood trauma
- first successful use of MPD for insanity defense (Rogue alters committed the crimes without the others knowing about it)
Evidence for DID being real
- different allergic responses
- different responses to the same medication
- different handedness
- handwriting differences between alters
- optical variability amongst alters (looking at eye muscle balance)
- psychogenic blindness (totally blind woman with DID changed after therapy of DID)
- functional brain imaging differences were found between DID and controls (they weren’t found when simulating identities)
DID neuroanatomy
tend to have
- lower hippocampus volumes (less integration of memory)
- less amygdala volumes (less affective defensive functioning)
- lower parietal structures (impairment with personal awareness)
What is the trauma model of DID?
Trauma (prerequisite) leads to DID via various biopsychosocial mediators and moderators (genetic vulnerabilities, developmental environment, stress, support)
Individuals with the disorder typically report multiple types of interpersonal maltreatment during childhood and adulthood (polyvictimisation during early stages of life)
DID and complex trauma
Majority of cases report incest or brutal sexual abuse often by a psychotic adult
- initially an adaptive defensive response
- the number of alters are associated with severity / duration of abuse
Finding that complex trauma causes DID
and neurobiological evidence that DID is a severe form of PTSD
What is the structural theory of dissociation?
Under extreme threat, our personalities split
- this split is based on our biological motivational systems, which dissociated from one another
The basis of the personalities is the daily (Trauma Avoidant apparently Normal Part) personality and the alters (trauma fixated emotional parts) reflect our fight, flight and freeze
According to this account: ptsd is a basic form of personality fragmentation (w/ one normal and emotional part) then you have secondary structural dissociation, and tertiary structural dissociation disorder
Outline the DID sociocognitive / fantasy model:
Emphasises:
- importance of social learning / expectancies
- trauma can be present but unnecessary
- DID = a disorder of self-understanding
DID results from:
- iatrogenic factors: inadvertent therapist cues (e.g. suggestive questioning about alters)
- media influence (television and film portrayals of DID)
- sociocultural expectations (regading the features of DID)
The model has these as antecedents, followed by mediators and moderators (fantasy proneness, suggestibility, cognitive distortion, social support, etc) then trauma and dissociation
