Dissociative Identity Disorder (W9)

Question 1

What’s a dissociative disorder?

Answer 1

When some aspect of cognition or experience becomes inaccessible to consciousness

Question 2

What does this result in?

Answer 2

A sudden disruption in continuity might affect one or more of consciousness, emotions, motivation, memory, or identity (Kring et al 2019)

Question 3

Is dissociation always harmful?

Answer 3

No ie when we completely lose track of where we when driving or when we’re concentrating on work, lose track of time and don’t notice what is going know around us

Question 4

What 3 categories are dissociative disorders separated into in the DSM-5?

Answer 4

1. Depersonalisation/derealisation: experiencing detachment from self and reality
2. Dissociative amnesia:
   loss of conscious access to memory
3. Dissociative Identity Disorder (DID) formally known as multiple personalities disorder have at least 2 personalties / alters

Question 5

DSM-5 Diagnostic criteria

Answer 5

A. Disruption of identity characterised by two or more distinct personality states (alters). This involves discontinuity in sense of self and altered cognition, behaviour, affect, perceptions, consciousness, memories, or sensory-motor functioning.
B. gaps in recalling events or important personal information that are beyond ordinary forgetting
C. Symptoms cause clinically significant distress or impairment to functioning.
D. The disturbance is not part of a broadly accepted cultural or religious practice. (In children, symptoms are NOT better explained by an imaginary playmate or fantasy play).
E. Symptoms are NOT due to drugs or a medical condition

Question 6

What is DID?

Answer 6

• Case reports describe how diff alters can like diff foods, diff allergies etc
• Primary alters might not be aware of the existence of other alters
• Not same as Sz

Question 7

Prevalence

Answer 7

• It’s more common in women > men (DSM5)

- Its rare, prevalence is around 0.5-1% or less, though actual figures vary (Slogar 2011)

Question 8

Comorbidity

Answer 8

Its comorbid with disorders such as
PTSD, Major Depression, Somatic symptoms (meaning a significant focus on physical symptoms to the extent that it may cause problems functioning)

Question 9

Prevalence over time and place

Answer 9

• No identified reports of DID before 1800 (Perhaps symptoms interpreted in diff ways)
• There have been increases in reported rates since 1970s ( Uchinuma and Sekina 2000)
  DID in pop culture ie Dr Jekyll and Mr Hyde
• In some cultures, where exps of possession are broadly accepted cultural practice, DID isn’t an appropriate diagnosis
• Theres some cultural diffs. Similar prevalence identified in USA, Canada, Netherlands, Norway and Turkey. Prevalence in India, Germany and Japan is much lower (Kring and Johnson 2019)

Question 10

Critical discussion - causes of DID

What is the post-traumatic model?

Answer 10

• DID results from severe trauma and abuse in childhood. Dissociation is a way of coping with trauma
• Dissociation can serve as defence mechanisms for the physical and emotional pain that arise from an experience to allow one to maintain a healthy lvl of functioning as if the event never happened (Kring and Johnson 2019)

Question 11

causes of DID - Socio-cognitive model?

Answer 11

• DID may be a form of role-playing in suggestible individuals
• It could be iatrogenic (induced through treatment) - in response to prompting by therapists or media
• Deception isn’t conscious
  (Kring & Johnson 2019)

Question 12

Evidence for the post-traumatic model?

Answer 12

• Most ppts in therapy for DID report severe childhood abuse (Dalenberg et al 2012)
• Factors in addition to a history of abuse, such as disorganized or disoriented attachment style and a lack of social or familial support best predict that an individual will develop DID (Forest,2001)

Question 13

Evidence for the socio-cognitive model?

Answer 13

• Evidence DID can be role played - hypnotized students instructed to let another personality come forward. Most adopted a v diff 2nd personality w/ a diff name (Boysen and Van Bergen 2014)
• Patients show partial implicit memories, meaning that alters share memories (Huntgenet al 2003)
• Therapists who diagnose DID tend to use hypnosis or ask patients to name alters (Powell & Gee 2000)
• Patients don’t always display alters before starting treatment (Powell and Gee 2000) however treatment can also reduce symptoms of DID (Kellett 2005)

Question 14

Limits of the evidence

Answer 14

• DID is rare so studies haven’t focused on the relationship between DID and trauma
• There are no prospective studies following children after trauma to see if they go on to develop DID
• Unethical to intentionally induce DID in therapy in order to gather experimental evidence to support a theory