Origin, Models, and Current Understandings

“As an undergraduate student in psychology, I was taught that multiple personalities were a very rare and bizarre disorder. That is all that I was taught on ... It soon became apparent that what I had been taught was simply not true. Not only was I meeting people with multiplicity; these individuals entering my life were normal human beings with much to offer. They were simply people who had endured more than their share of pain in this life and were struggling to make sense of it.”

― Deborah Bray Haddock, The Dissociative Identity Disorder Sourcebook

DID Research

Origin, Models, and Current Understandings

Dalenberg, C., Brand, B., Gleaves, D., Dorahy, M., Loewenstein, R., Cardeña, E., ... Spiegel, D. (2012). Evaluation of the evidence for the trauma and fantasy models of dissociation. Psychological Bulletin 138(3), 550-588. doi:10.1037/a0027447

Abstract: The relationship between a reported history of trauma and dissociative symptoms has been explained in 2 conflicting ways. Pathological dissociation has been conceptualized as a response to antecedent traumatic stress and/or severe psychological adversity. Others have proposed that dissociation makes individuals prone to fantasy, thereby engendering confabulated memories of trauma. We examine data related to a series of 8 contrasting predictions based on the trauma model and the fantasy model of dissociation. In keeping with the trauma model, the relationship between trauma and dissociation was consistent and moderate in strength, and remained significant when objective measures of trauma were used. Dissociation was temporally related to trauma and trauma treatment, and was predictive of trauma history when fantasy proneness was controlled. Dissociation was not reliably associated with suggestibility, nor was there evidence for the fantasy model prediction of greater inaccuracy of recovered memory. Instead, dissociation was positively related to a history of trauma memory recovery and negatively related to the more general measures of narrative cohesion. Research also supports the trauma theory of dissociation as a regulatory response to fear or other extreme emotion with measurable biological correlates. We conclude, on the basis of evidence related to these 8 predictions, that there is strong empirical support for the hypothesis that trauma causes dissociation, and that dissociation remains related to trauma history when fantasy proneness is controlled. We find little support for the hypothesis that the dissociation-trauma relationship is due to fantasy proneness or confabulated memories of trauma.

https://www.researchgate.net/publication/221695375_Evaluation_of_the_evidence_for_the_trauma_and_fantasy_models_of_dissociation

 

Dell, P. F. (2006). A new model of dissociative identity disorder. Psychiatric Clinics of North America, 29(1), 1-26. doi:10.1016/j.psc.2005.10.013

Abstract: Data from 220 persons who had DID were used to compare three models of DID: the DSM-IV's classic model of DID (ie, multiple personalities + switching + amnesia), the subjective/phenomenological model of DID (Box 1), and the sociocognitive model of DID. The DSM-IV narrowly portrays DID as an alter disorder; the subjective/phenomenological model portrays DID as a far more complex dissociative disorder. The data indicate that the subjective/ phenomenological model of DID is a superior predictor of the dissociative phenomena of DID. The three studies [14,70] that corroborate the subjective/phenomenological model of DID are important. They show that the subjective/phenomenological model of DID is more comprehensive and more accurate than the DSM-IV's classic model of DID. They also refute the sociocognitive model of DID. The subjective/phenomenological model of DID was deduced from a novel, empirically supported model of pathological dissociation [4]; that model fully explains the empirical literature on DID, whereas the DSM-IV model of DID can account for little of that literature.

https://www.researchgate.net/publication/7247074_A_New_Model_of_Dissociative_Identity_Disorder

 

Dell, P. F., & O'Neil, J. A. (2009). Dissociation and the dissociative disorders: DSM-V and beyond. New York: Routledge.

Summary: Dissociation and the Dissociative Disorders is a book that has no real predecessor in the dissociative disorders field. It reports the most recent scientific findings and conceptualizations about dissociation; defines and establishes the boundaries of current knowledge in the dissociative disorders field; identifies and carefully articulates the field’s current points of confusion, gaps in knowledge, and conjectures; clarifies the different aspects and implications of dissociation; and sets forth a research agenda for the next decade. In many respects, Dissociation and the Dissociative Disorders both defines and redefines the field.

https://books.google.com/books/about/Dissociation_and_the_Dissociative_Disord.html?id=e-6WHeIf-dgC

 

Dorahy, M., Brand, B., Sar, V., Krugar, C., Stavropoulos, P., Martinez, A., ... & Middleton, W. (2014). Dissociative identity disorder: An empirical overview. Australian and New Zealand Journal of Psychiatry, 48(5), 402-417. doi:10.1177/0004867414527523

Abstract: Objective: Despite its long and auspicious place in the history of psychiatry, dissociative identity disorder (DID) has been associated with controversy. This paper aims to examine the empirical data related to DID and outline the contextual challenges to its scientific investigation.

Methods: The overview is limited to DID-specific research in which one or more of the following conditions are met: (i) a sample of participants with DID was systematically investigated, (ii) psychometrically-sound measures were utilised, (iii) comparisons were made with other samples, (iv) DID was differentiated from other disorders, including other dissociative disorders, (v) extraneous variables were controlled or (vi) DID diagnosis was confirmed. Following an examination of challenges to research, data are organised around the validity and phenomenology of DID, its aetiology and epidemiology, the neurobiological and cognitive correlates of the disorder, and finally its treatment.

Results: DID was found to be a complex yet valid disorder across a range of markers. It can be accurately discriminated from other disorders, especially when structured diagnostic interviews assess identity alterations and amnesia. DID is aetiologically associated with a complex combination of developmental and cultural factors, including severe childhood relational trauma. The prevalence of DID appears highest in emergency psychiatric settings and affects approximately 1% of the general population. Psychobiological studies are beginning to identify clear correlates of DID associated with diverse brain areas and cognitive functions. They are also providing an understanding of the potential metacognitive origins of amnesia. Phase-oriented empirically-guided treatments are emerging for DID.

Conclusions: The empirical literature on DID is accumulating, although some areas remain under-investigated. Existing data show DID as a complex, valid and not uncommon disorder, associated with developmental and cultural variables, that is amenable to psychotherapeutic intervention.

https://www.researchgate.net/publication/262025048_Dissociative_identity_disorder_An_empirical_overview

 

Kluemper, N. & Dalenberg, C. (2014). Is the dissociative adult suggestible? A test of the trauma and fantasy models of dissociation. Journal of Trauma & Dissociation, 15(4). doi:10.1080/15299732.2014.880772

Abstract: Psychologists have long assumed a connection between traumatic experience and psychological dissociation. This hypothesis is referred to as the Trauma Model of dissociation. In the last decade, a series of papers have been published that question this traditional causal link, proposing an alternative Fantasy Model of dissociation. In this research, the relationship among dissociation, suggestibility, and fantasy proneness were examined. Suggestibility was measured through the Gudjonsson Scale of Interrogative Suggestibility (GSS), as well as an autobiographically based version of this measure based on the events of September 11, 2001. Consistent with prior research and with the Trauma Model, dissociation correlated positively with trauma severity (r = .32, p < .01) and fantasy proneness (r = .60, p < .01). Inconsistent with the Fantasy Model, dissociation did not correlate with the neutral form of the Gudjonsson, and correlated negatively (r = -.24, p < .05) with the trauma-focused form of this suggestibility measure. Although some participants did become quite emotional during the procedure, the risk/benefit ratio was perceived by almost all participants to be positive, with more reactive individuals evaluating the procedure more positively. The results consistently support the Trauma Model of dissociation and fail to support the Fantasy Model of dissociation.

https://www.researchgate.net/publication/261217759_Is_the_Dissociative_Adult_Suggestible_A_Test_of_the_Trauma_and_Fantasy_Models_of_Dissociation

 

Reinders, A. A., Willemsen, A. T., Vos, H. P., Boer, J. A., & Nijenhuis, E. R. (2012). Fact or factitious? A psychobiological study of authentic and simulated dissociative identity states. PLoS ONE, 7(6). doi:10.1371/journal.pone.0039279

Abstract: Background: Dissociative identity disorder (DID) is a disputed psychiatric disorder. Research findings and clinical observations suggest that DID involves an authentic mental disorder related to factors such as traumatization and disrupted attachment. A competing view indicates that DID is due to fantasy proneness, suggestibility, suggestion, and role-playing. Here we examine whether dissociative identity state-dependent psychobiological features in DID can be induced in high or low fantasy prone individuals by instructed and motivated role-playing, and suggestion.

Methodology/Principal Findings: DID patients, high fantasy prone and low fantasy prone controls were studied in two different types of identity states (neutral and trauma-related) in an autobiographical memory script-driven (neutral or trauma-related) imagery paradigm. The controls were instructed to enact the two DID identity states. Twenty-nine subjects participated in the study: 11 patients with DID, 10 high fantasy prone DID simulating controls, and 8 low fantasy prone DID simulating controls. Autonomic and subjective reactions were obtained. Differences in psychophysiological and neural activation patterns were found between the DID patients and both high and low fantasy prone controls. That is, the identity states in DID were not convincingly enacted by DID simulating controls. Thus, important differences regarding regional cerebral bloodflow and psychophysiological responses for different types of identity states in patients with DID were upheld after controlling for DID simulation.

Conclusions/Significance: The findings are at odds with the idea that differences among different types of dissociative identity states in DID can be explained by high fantasy proneness, motivated role-enactment, and suggestion. They indicate that DID does not have a sociocultural (e.g., iatrogenic) origin.

http://journals.plos.org/plosone/article?id=10.1371/journal.pone.0039279

 

Stickley, T. & Nickease, R. (2006). Becoming one person: Living with dissociative identity disorder. Journal of Psychiatric and Mental Health Nursing, 13, 180-187.

Abstract: Dissociative identity disorder is a rare diagnosis, although people currently with a diagnosis of psychosis may in fact be experiencing what is associated with the disorder. This article is co-authored by a nurse and a person who has lived with alters (multiple personalities) for nearly all of her life. Because of the rarity of the diagnosis, there is much misunderstanding and ignorance among lay people and mental health professionals. This article therefore clarifies historical and contemporary issues surrounding this particular mental health problem both through examining the literature and through narrative of the person’s experience. Special attention is given to the reality of coping with the difficulties that dissociative identity disorder create.

http://clausenclassroom.pbworks.com/f/Becoming%2BOne%2BPerson.pdf

 

Vissia, E., Giesen, M., Chalavi, S., Nijenhuis, E., Draijer, N., Brand, B., & Reinders, A. (2016). Is it trauma- or fantasy-based? Comparing dissociative identity disorder, post-traumatic stress disorder, simulators, and controls. Acta Psychiatrica Scandinavica. doi:10.1111/acps.12590

Abstract: Objective: The Trauma Model of dissociative identity disorder (DID) posits that DID is etiologically related to chronic neglect and physical and/or sexual abuse in childhood. In contrast, the Fantasy Model posits that DID can be simulated and is mediated by high suggestibility, fantasy proneness, and sociocultural influences. To date, these two models have not been jointly tested in individuals with DID in an empirical manner.

Method: This study included matched groups [patients (n = 33) and controls (n = 32)] that were compared on psychological Trauma and Fantasy measures: diagnosed genuine DID (DID-G, n = 17), DID-simulating healthy controls (DID-S, n = 16), individuals with post-traumatic stress disorder (PTSD, n = 16), and healthy controls (HC, n = 16). Additionally, personality-state-dependent measures were obtained for DID-G and DID-S; both neutral personality states (NPS) and trauma-related personality states (TPS) were tested.

Conclusion: For Trauma measures, the DID-G group had the highest scores, with TPS higher than NPS, followed by the PTSD, DID-S, and HC groups. The DID-G group was not more fantasy-prone or suggestible and did not generate more false memories. Malingering measures were inconclusive. Evidence consistently supported the Trauma Model of DID and challenges the core hypothesis of the Fantasy Model.