Dissociative Identity Disorder Flashcards
DSM -5 -> Dissociative Disorders
- disruption in the normal integration of consciousness, identity, memory, perception
- criteria A disruption of identity = 2 + distinct personality states
- Criteria B = gaps in recall of everyday events , personal info
sybil - social Phenomenon
-16 personalities
- most alters had limited/ no knowledge of each other
Rise of DID
- First included in DSM 3 as Multiple personality disorder + Seen as extremely rare
- Braun, kluft + Putman join DSM committee + discovered over 800 new cases of DID
- Began to rise rapidly till 1986
Fall of DID
-Main journal for DID ceased publication
- DSM -4 moved DID from No 1 to No 4
-sharp rise in cases has many iterpretations
- some believe its due to greater awareness = identification of previously undiagnosed cases
-others believe there was overdiagnosis
sybil exposed
- she was coached + encouraged to produce multiple personalities during therapy
- Frequently doubled prescription
Fantasy of DID
-DID is a fantasy/suggestbity phenomenon
-is culture-bound + iatrrogenic (caused by therapists leading questions)
- Giesbrecht et aI enhancing propensity towards pseudo-memories mediated by heightened levels of interrogative suggestibility + fantasy proneness
sociocognitive/ fantasy Model
-Dalenberg et al-> fantasy proneness +suggestibility are intrinsic characteristics of some indivs which with inappropriate therapy = false memories + multiple personalities
-DID is false
- inappropriate therapy = leading questions, amplification over time
suggestibility As intrinsic feature - implantation of false memories
-Loftus + Pickrell -> Chris supplied with 3 true events + fake event of being lost in a shopping mall
- wrote about all 4 events
- begun to remember more + more about the false memory
- provided rich details about where he got lost + what he thought
- when told to select false memory he selected a real one
-repeated + 1/3 thought they remembered the false memory
suggestibility + amplification of disorder over time
-spanos-> early 20th century rarely displayed more than 2/3 identities
- modern patients displayed 15 - 100 aLters
-suggests DID alter pattern of recall as understanding expectations + diagnosing procedures create rather than discover the disorder
Trauma Model
-real adverse traumatic experience = defence Mechanisms = True DID or DTSD
- Defence Mechanisms dissociation fantasy proneness
-extreme dissoc fantasy pronness = DID , less extreme=PTSD
mediators increasing likelihood of dissociation = stress , low social support, young age, env + genetics
Dissociation defence Mechanism
-Dalenberg + carison -> avoidance techniques (derealisation depersonalisation) reflect effort to reduce distress through distancing
-relief reinforces efforts = increase in frequency
- Allen et al -> higher mean score childhood trauma associated with higher probability of dissociative tendencies in adulthood
fantasy proneness defence mechanism
-Merckleback et al- fuelled by need to escape adverse childhood experiences + function as a defensive reaction
Van Herten et al-> PTSD + DID ppts showed much higher levels of dissociation + fantasy proneness than controls
suggestibility + leading questions study
-vassia et al-> DID ppts NIS = neutral identity state
-DID ppts Tis = trauma
-DID -S = ppts stimulate DID
- PTSD
- controls
- Told a story then interviewed with leading q’s
- found DID weren’t more vulnerable to leading q’s
-Tis least suggestible
Neuropsychology of DID
-Sar et al >
- baseline cerebral blood flow measurements were lower in DID in orbitofrontal regions
fantasy proneness contrasting evidence
- compared DID ppts with high-fantaSY prone non-DID controls
-Reinders
-DID showed larger response to trauma identity state US neutral compared to control - shows differences aren’t due to fantasy proneness
Criteria B- working memory N back test
- Vissia et al >
-DID ppts performed poorly when in TIS - controls + perf DID-s performed similarly whether in NIS or TIS
Pattern recognition techniques
- Reinders et al->
- able to identify DID to an accuracy of 74 %
- found widespread grey + white matter spatially dependent patterns of abnormal morphology in indivs with DID compared to controls
Treatment survey
- Brand et al surveyed 36 experts
- 4 stage process:
1 ) feeling safe + building AlIiance
2) CBT
3) Direct trauma based work
4) Increasing daily functioning skills + emotional regulation
Treatment outcome
- Brand + Loewenstein
- somewhat reduced symptoms of DID following long term therapy
- Although theres improvement ,not cured
Etiology of depersonalisation/ derealisation disorder
- Guralnick et al-> PET study of indivs with disorder showed atypical activity in regions integrating info from sensory cortex + bodily cues
-Renaud -> brief symptoms induced in healthy indivs by providing mismatched sensory experiences by wearing goggles that distort visual info
DID symptoms can be role played
- when instructed to generate a second personality, many are able to do this
- indicates people can role-play DID
Therapists reinforcing DiD
symptoms
-powell + Gee-> therapists hypnosis to urge clients to unbury unremembered experiences
- most patients unaware of having alternative personality states until after treatment begins
- As treatment begins report more personalities
Alternate personalities share memories
-defining feature of DID = inability to recall info experienced by 1 personality when in another
- Postma et al-> explicit memory tests
- Taught initial word list then asked to complete implicit test
-21 ppts claim no memory of 1 St session however performed similar to those without DID
-shows memories transferred through personalities
Psychoeducation treatment
- Myrick et Al
-help understand dissociation + identify triggers in day-to-day life
Psychodynamic treatment
-MacGreggor-> overcome repressions
- However some use hypnosis which encourages them to go back into early childhood trauma memories = age regression
- Hope it will help them realise childhood threats no longer present in adult life
- However Lilenfeld says it can exacerbate symptoms
