Corroborating premorbid dissociative symptomatology in dissociative identity disorder.

Clinicians are often cautious about making the diagnosis of Dissociative Identity Disorder (DID). The existence of corroborating evidence that symptoms of DID existed prior to assessment may address concerns about the genuineness of individual cases. The authors report the results of a survey of clinicians to determine the frequency of corroboration that clients' DID symptoms existed prior to being diagnosed or prior to therapy. On the basis of 446 cases of DID, clinicians reported some form of corroboration (e.g., reports from family, medical records) in 73% of cases for symptoms prior to diagnosis and in 67% of cases for symptoms prior to therapy. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Interidentity memory transfer in dissociative identity disorder.

Controversy surrounding dissociative identity disorder (DID) has focused on conflicting findings regarding the validity and nature of interidentity amnesia, illustrating the need for objective methods of examining amnesia that can discriminate between explicit and implicit memory transfer. In the present study, the authors used a cross-modal manipulation designed to mitigate implicit memory effects. Explicit memory transfer between identities was examined in 7 DID participants and 34 matched control participants. After words were presented to one identity auditorily, the authors tested another identity for memory of those words in the visual modality using an exclusion paradigm. Despite self-reported interidentity amnesia, memory for experimental stimuli transferred between identities. DID patients showed no superior ability to compartmentalize information, as would be expected with interidentity amnesia. The cross-modal nature of the test makes it unlikely that memory transfer was implicit. These findings demonstrate that subjective reports of interidentity amnesia are not necessarily corroborated by objective tests of explicit memory transfer. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

ECT in dissociative identity disorder and comorbid depression

AIMS: Awareness of hereditary breast and ovarian cancer in both the general public and the medical profession is increasing. Individuals who may be at risk on the basis of a family history are requesting risk determination and appropriate management in a variety of settings. Risk determination relies largely on pedigree analysis and epidemiological data. METHODS: We describe five individuals presenting in the family cancer or genetic counselling clinic where a factitious family or personal history led to erroneous risk estimation. Common factors in these families are a history of benign breast disease, poor communication within families, long survival with early onset or bilateral disease, a lack of detailed knowledge of the illness and treatment in close relatives and inconsistencies in the history in repeated consultations.     

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. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

A naturalistic study of dissociative identity disorder and dissociative disorder not otherwise specified patients treated by community clinicians.

[Correction Notice: An erratum for this article was reported in Vol 1(3) of Psychological Trauma: Theory, Research, Practice, and Policy (see record 2009-18612-003). Author Ruth Lanius’s name was misspelled as Ruth Lanins; author Scot McNary’s name was misspelled Scott McNary; author Clare Pain’s name was misspelled Claire Pain; and the affiliation for Richard Loewenstein should have read Sheppard Pratt Health System.] The goals of this naturalistic, cross-sectional study were to describe the patient, therapist, and therapeutic conditions of an international sample of dissociative disorder (DD) patients treated by community therapists and to determine if community treatment for DD appears to be as effective as treatment for chronic PTSD and conditions comorbid with DD. Analyses found that across both patient (N = 280) and therapist (N = 292) reports, patients in the later stages of treatment engaged in fewer self-injurious behaviors, had fewer hospitalizations, and showed higher levels of various measures of adaptive functioning (e.g., GAF) than those in the initial stage of treatment. Additionally, patients in the later stages of treatment reported lower symptoms of dissociation, posttraumatic stress disorder, and distress than patients in the initial stage of treatment. The effect sizes for Stage 5 versus Stage 1 differences in DD treatment were comparable to those published for chronic PTSD associated with childhood trauma and depression comorbid with borderline personality disorder. Given the prevalence, severity, chronicity, and high health care costs associated with DD, these results suggest that extended treatment for DD may be beneficial and merits further research. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

The evolution of alter personality states in dissociative identity disorder.

Though several theories have been proposed to explain the manifestation of alter personality states in dissociative identity disorder (DID), the majority have failed to explain how alters develop over the life span and why the disorder becomes more complex after childhood. Expanding on S. S. Marmer (1991) and F. W. Putnam's (1995) concept of a developmental window of vulnerability for DID, this article proposes a 3-stage model of alter personality formation, integrating theory and research on hypnotizability and imaginary companionship with perspectives on individuation and identity formation in adolescence. The author also speculates about possible courses of development leading to other trauma-related disorders. The author proposes that alters evolve out of childhood imaginary companions that merge with dissociative states of consciousness before individuating into distinct personality states during adolescence. Treatment considerations are raised emphasizing the need to diagnose DID early in its course of development before the alters have become invested in their separateness and begun fighting for control over the body. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Identifying dissociative identity disorder: A self-report and projective study.

This study compared 21 female adult psychiatric patients diagnosed with dissociative identity disorder (DID) with 21 female adult nondissociative psychiatric patients to determine whether DID patients exhibit a distinguishing set of clinical features, and perceptual, attentional, and cognitive processes. Participants were assessed with the Dissociative Disorders Interview Schedule to assess diagnostic status. Group scores on the Dissociative Experiences Scale, Tellegen Absorption Scale, Childhood Trauma Questionnaire, Brief Symptom Inventory, and the Rorschach test were compared. DID participants reported earlier and more severe childhood trauma, more dissociative symptoms, and a greater propensity for altered states of consciousness. The DID participants also exhibited increased projective and imaginative activity, a diminished ability to integrate mental contents, a complex and driven cognitive style, and a highly unconventional view of reality. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

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. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Questioning premorbid dissociative symptomatology in dissociative identity disorder: Comment on Gleaves, Hernandez and Warner (1999).

Comments on an article by D. H. Gleaves et al (see record 1999-03012-003) which purported to refute the sociocognitive model (SCM) of dissociative identity disorder by showing that many of the symptoms associated with dissociative identity disorder are displayed by patients before entering therapy or prior to diagnosis. The present authors argue that Gleaves et al's results do not refute the SCM and are in fact supportive of that model. The present authors also argue that the Gleaves et al study suffers from several deficiencies, including a misunderstanding of the SCM and its predictions concerning iatrogenesis, deficiencies in the manner in which the survey was conducted, and a failure to note some disturbing trends in the results that were obtained. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

The sociocognitive model of dissociative identity disorder: A reexamination of the evidence.

According to the sociocognitive model of dissociative identity disorder (DID; formerly, multiple personality disorder), DID is not a valid psychiatric disorder of posttraumatic origin; rather, it is a creation of psychotherapy and the media. Support for the model was recently presented by N. P. Spanos (see record 1994-41224-001). In this article, the author reexamines the evidence for the model and concludes that it is based on numerous false assumptions about the psychopathology, assessment, and treatment of DID. Most recent research on the dissociative disorders does not support (and in fact disconfirms) the sociocognitive model, and many inferences drawn from previous research appear unwarranted. No reason exists to doubt the connection between DID and childhood trauma. Treatment recommendations that follow from the sociocognitive model may be harmful because they involve ignoring the posttraumatic symptomatology of persons with DID. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Personality differences on the Rorschach of dissociative identity disorder, borderline personality disorder, and psychotic inpatients.

Patients with dissociative identity disorder (DID) are often diagnosed with borderline personality disorder (BPD) and misdiagnosed with psychotic illnesses. This study is designed to determine whether the Rorschach protocols of 67 patients with DID differ from those of 40 patients with BPD and 43 patients with psychotic disorder (PSD) in variables reflecting capacity for working alliance, complexity of experience, and ability to reason despite traumatic flooding. As theoretically and clinically predicted, the DID group could be distinguished from the PSD sample by the DID group’s significantly higher level of traumatic associations alongside their more logical reasoning (e.g., Trauma Content Index [TCI], WSUM6). In comparison to the BPD group who, by definition, were also likely to dissociate and struggle with other trauma based symptoms, the DID sample showed greater social interest (Sum H), self-reflective capacity (FD; Form Dimension), ability to perceive more accurately and think more logically (X-, WSUM6). The authors discuss the treatment applications of these findings and make suggestions for further research. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

The etiology of dissociative identity disorder: Reply to Gee, Allen and Powell (2003).

Responds to a comment by T. Gee et al (see record 2003-04125-019) about the authors' original article (see record 1999-03012-003) which studied how clinicians treating dissociative identity disorder (DID) were or were not gathering and utilizing corroborative data. Results of this study show that many of the symptoms associated with DID were displayed by patients before entering therapy or prior to diagnosis. Gee et al argue that these results do not refute the sociocognitive model (a modified iatrogenesis model) of DID, but actually support it. The present authors maintain that their data did clearly contradict the iatrogenesis position. It is asserted that Gee et al's comment illustrates many important flaws of the iatrogenic DID argument, primarily that it is unscientific by virtue of being nondisconfirmable, and that it can only be maintained by adhering to false assumptions about DID and by misinterpreting data. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

"A naturalistic study of dissociative identity disorder and dissociative disorder not otherwise specified patients treated by community clinicians": Correction to Brand et al. (2009).

Reports an error in A naturalistic study of dissociative identity disorder and dissociative disorder not otherwise specified patients treated by community clinicians by Bethany Brand, Catherine Classen, Ruth Lanins, Richard Loewenstein, Scott McNary, Claire Pain and Frank Putnam (Psychological Trauma: Theory, Research, Practice, and Policy, 2009[Jun], Vol 1[2], 153-171). Author Ruth Lanius’s name was misspelled as Ruth Lanins; author Scot McNary’s name was misspelled Scott McNary; author Clare Pain’s name was misspelled Claire Pain; and the affiliation for Richard Loewenstein should have read Sheppard Pratt Health System. (The following abstract of the original article appeared in record 2009-08949-005.) The goals of this naturalistic, cross-sectional study were to describe the patient, therapist, and therapeutic conditions of an international sample of dissociative disorder (DD) patients treated by community therapists and to determine if community treatment for DD appears to be as effective as treatment for chronic PTSD and conditions comorbid with DD. Analyses found that across both patient (N = 280) and therapist (N = 292) reports, patients in the later stages of treatment engaged in fewer self-injurious behaviors, had fewer hospitalizations, and showed higher levels of various measures of adaptive functioning (e.g., GAF) than those in the initial stage of treatment. Additionally, patients in the later stages of treatment reported lower symptoms of dissociation, posttraumatic stress disorder, and distress than patients in the initial stage of treatment. The effect sizes for Stage 5 versus Stage 1 differences in DD treatment were comparable to those published for chronic PTSD associated with childhood trauma and depression comorbid with borderline personality disorder. Given the prevalence, severity, chronicity, and high health care costs associated with DD, these results suggest that extended treatment for DD may be beneficial and merits further research. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Beliefs about the prevalence of dissociative identity disorder, sexual abuse, and ritual abuse among religious and nonreligious therapists.

Four hundred ninety-seven Christian therapists and 100 members of the American Psychological Association returned questionnaires indicating the prevalence of dissociative identity disorder (DID), sexual abuse, and ritual abuse in their clinical practices. There was a low rate of diagnosing DID and ritual abuse among all respondents. Christian psychologists were slightly more likely to diagnose ritual abuse than other psychologists, but they were no more likely to diagnose DID or sexual abuse. No differences were observed in diagnosing ritual abuse or DID between Christian psychologists, other licensed Christian therapists, nonlicensed Christian therapists, and lay counselors. Licensed Christian therapists who are not psychologists reported a greater prevalence of sexual abuse among their clients than nonlicensed Christian therapists and lay counselors. Implications for clinical practice are discussed. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Rorschach indicators of dissociative identity disorders: clinical utility and theoretical implications

A series of 1,4-dihydropyridines bearing a coumarin moiety in 4-position was synthesized. The compounds were evaluated for inotropic, chronotropic and calcium antagonist activities. The replacement of the o-nitrophenyl moiety of nifedipine with a coumarin or phenylcoumarin system is accompanied by a decrease of the activity on myocardial and vascular parameters, but the synthesized compounds showed selective inhibiting effects on cardiac contractility and frequency.     

Interrelationships of conversion, psychogenic pain, and dissociative disorder symptoms.

Among 29 male hysterics, psychogenic pain and conversion symptoms were positively correlated but were inversely related to dissociative symptoms. This suggests that conversion and pain disorders be merged into 1 diagnosis and that dissociative disorders be considered a separate, although related, entity. Data support the DSM-II scheme for hysteria better than its DSM-III counterpart. (2 ref) (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Effectiveness of cognitive-behavioral treatment for panic disorder versus treatment as usual in a managed care setting: 2-year follow-up.

Eighty clients meeting criteria for panic disorder and receiving either panic control therapy (PCT; M. G. Craske, E. Meadows, & D. H. Barlow, 1994) or treatment as usual (TAU) in a managed care setting were assessed 1 and 2 years following acute treatment. PCT was provided by therapists with little or no previous exposure to cognitive-behavioral therapies. Analyses of the full intent-to-treat sample revealed no significant differences between the treatments across the follow-up period. However, when treatment completer status was added as a moderator, those receiving PCT showed lower levels of panic severity and phobic avoidance and a greater likelihood of achieving and maintaining clinically significant change. Benzodiazepine use during follow-up was associated with greater panic severity for those clients who received PCT, but no such relationship was found for TAU clients. Results are discussed in relation to the dissemination and effectiveness of PCT as well as evidence-based psychotherapies more generally. (PsycINFO Database Record (c) 2010 APA, all rights reserved)