NSCI 302: DID

dissociation

• daydreaming and mind-wandering

• sleep less = more dissociation

• 20% of all ppl with psychiatric illnesses report significant dissociative symptoms = transdiagnostic

Janet

• notion of dissociation being a response to trauma

• viewed dissociation as an unconscious, automatic, defense coping mechanism to highly aversive events

dissociation symptoms

• common lapses in attention

• minor memory lapses

• daydreaming

• depersonalization/derealization

• dissociative amnesia

• DID

DSM-5 dissociative disorders

• depersonalization/derealization

• dissociative amnesia

• DID

depersonalization

• experiences of unreality, detachment or being an outside observer

• not in control

derealization

feels like surroundings are not real

dissociative amnesia

• controversial: some ppl believe it does not exist

• inability to recall important autobiographical info - usually traumatic

• localized amnesia for specific events

• generalized amnesia for identity and life history

DID

previously known as multiple personality disorder (in ICD-10 and DSM-IV)

DSM-5-TR DID criteria

• disruption of identity characterized by 2 or more distinct personality states

• recurrent gaps in recall of everyday events, important personal info or traumatic events - not the same as ordinary forgetting

• symptoms cause distress or impairment in social, occupational areas

• disturbance is not a normal part of a broadly accepted cultural or religious practice

• in children: symptoms are not explained by imaginary playmates

Epidiomology

• 1-2% of gen pop

• 1-10% in inpatient setting

• more common in females than males (up to 9x as common)

• symptoms more severe in females

• ½ to 2/3 of ppl with borderline personality meet criteria for DID

chronic stress and DID

• involves severe and chronic childhood trauma

• chronic stressor: physical, emotional or sexual abuse

• “most severe, chronic, complex childhood-onset form of PTSD”

post-traumatic/ trauma model of DID

• individuals with the capacity to dissociate due to genetics are left with one or more distinct self-states that they think and feel are not them

• relates back to Janet

• some people think it’s iatrogenic

interpersonality amnesia

• various personalities perform differently on psychological tests (IQ, personality tests)

• personalities diff in terms of handwriting and other behavioural traits

• creates legal conundrums: is one identity responsible for the actions of another identity? Can they stand in trial?

forms of awareness between personalities

1. mutually amnestic

2. unidirectional amnestic

3. co-conscious

mutually amnestic

no awareness/memory of each other

unidirectional amnestic

one personality remembers the other but the other doesn’t

co-conscious

personalities remember each other and could communicate internally

three faces of eve

• Chris sizemore’s life

• Eve white, eve black and jane (southern)

• by thigpen + cleckley

rising diagnoses

• starting in 1980, cases were rising rapidly

• 39 → 212 (70s → 80s)

spanos thesis: sociocognitive model of DID (component of fantasy model of DID)

• Spanos argues that DID was a “social construction”

• DID changed since becoming popular in the 80s: older cases = 2-3 personalities; newer cases = involved a dozen

• only small number of psychiatrists reported seeing many of the cases

• DID is a form of role playing between patients and therapists

• patiens: seeking attention

• therapists: urge for discovery

fantasy model of DID

• in therapeutic setting w ppl that are prone to suggestions, trauma manifests in the form of DID

• ???

misconceptions

1. DID is a fad

2. DID is primarily diagnosed in North America

3. DID is rare

DID is a fad

no evidence that there has been a decline in number of diagnoses

DID is primarily diagnosed in North America

studies and diagnoses present in every continent other than antarctica

DID is rare

1-1.5% of representative community samples

trauma-focused triphasic definition

each phase overlaps w the next

treatment

• trauma-focused triphasic = highest rate of success

trauma-focused triphasic phases

1. symptom stabilization

2. step-wise processing of trauma

3. integration of identities

symptom stabilization

teaching of affect and impulse regulation skills and communication and cooperation skills between dissociated states

step-wise processing of trauma

teaching and practicing containment of traumatic memories

integration of identities

• integrating all identities into one

• reducing dissociation as coping mechanism

structural neuroimaging

• smaller hippocampi - inversely correlated with severity of childhood mistreatment

• smaller amygdalae

• decreased volume of parietal structures like posterior parietal cortex

• larger white matter tracts

psychophysiological diff

• higher heart rate freq

• higher systolic blood pressure

• higher diastolic blood pressure

• lower heart rate variability

• higher sensori-motor rating

• higher emotional rating

• NOT ACTING

functional neuroimaging

• during identity changes = lower visual cortex function

• bilateral activation of nucleus accumbens

• regional cerebral blood flow increase in emotional personality compared to apparently normal personality in primary somatosensory, motor and premotor cortex

• as well as pre supplementary motor area and dorsomedial prefrontal cortex