Dissociative identity as a continuum from healthy mind to psychiatric disorders: Epistemological and neurophenomenological implications approached through hypnosis.

The topic of multiple personality, redefined as Dissociative Identity Disorders (DIDs) in the DSM-5, is an intriguing and still debated disorder with a long history and deep cultural and epistemological implications, extending up to the idea of possession. Hypnosis is an appealing and valuable model to manipulate subjective experience and get an insight on both the physiology and the pathophysiology of the mind-brain functioning; it and has been closely connected with DIDs and possession since its origin in 18th century and as recently proved the capacity to yield a loss of sense of agency, mimicking delusions of alien control and spirit possession. In this study we report on five very uncommon "hypnotic virtuosos" (HVs) free from any psychiatric disorder, spontaneously undergoing the emergence of multiple identities during neutral hypnosis; this allowed us to check the relationship between their experience and fMRI data. During hypnosis the subjects underwent spontaneous non-intrusive experiences of other selves which were not recalled after the end of the session, due to post-hypnotic amnesia. The fMRI showed a significant decrease of connectivity in the Default Mode Network (DMN) especially between the posterior cingulate cortex and the medial prefrontal cortex. Our results and their contrast with the available data on fMRI in DIDs allows to draw the hypothesis of a continuum between healthy mind - where multiple identities may coexist at unconscious level and may sometimes emerge to the consciousness - and DIDs, where multiple personalities emerge as dissociated, ostensibly autonomous components yielding impaired functioning, subject's loss of control and suffering. If this is the case, it seems more reasonable to refrain from seeking for a clear-cut limit between normality (anyway a conventional, statistical concept) and pathology, and accept a grey area in between, where ostensibly odd but non-pathological experiences may occur (including so-called non-ordinary mental expressions) without calling for treatment but, rather, for being properly understood.

[Disturbo dissociativo d'identità, auto-ipnosi e sintomi simil-psicotici: da un caso clinico a un problema di diagnosi differenziale].

We report a case of a forty-nine-year-old patient suffering from his first psychiatric episode, who required hospitalization in a psychiatric unit. The presence of mood alterations with Schneiderian first-rank symptoms could have suggested an initial diagnosis of bipolar disorder (BD) with psychotic symptoms, directing the patient towards a definite therapeutic process. However, we hypothesized that the presence of a clear dissociative state similar to the hypnotic trance preceded by an uncontrolled self-hypnosis process, the presence of 'inner voices' and a high vulnerability to dissociation, were all elements that may reasonably lead to a diagnosis of Dissociative Identity Disorder (DID). Several authors have reported the presence of psychotic-like symptoms in patients with DID. However, in clinical practice there is a tendency not to acknowledge the possibility of dissociative disorders diagnoses, in favor of others more frequent psychiatric disorders. This paper aims to highlight some etiopathogenetic and psychopathological features that might help clinicians in identifying a DID.

[Identity and dissociation in cyberspace. A case of dissociative identity disorder associated with internet role playing]. / Identität und Dissoziation im Cyberspace. Kasuistik einer dissoziativen Identitätsstörung im Zusammenhang mit einem Internet-Rollenspiel.

OBJECTIVE: By mediating dissociative experiences, the Internet can challenge the boundaries of people's sense of identity. To illustrate this hypothesis, a case of dissociative identity disorder (DID) is presented. CLINICAL PICTURE: A young unemployed woman created and frequently played several characters in an online game. For more than 2 years she spent up to 12 h a day in the Internet, assuming various personalities, which in return intruded upon her neglected real life. TREATMENT AND OUTCOME: During the course of an inpatient psychotherapeutic treatment, the clinical diagnosis of DID was confirmed by psychometric testing. After 12 weeks of psychotherapy, the patient had managed to identify her fragmented identities as character traits and integrated them into her core personality. She rearranged her real everyday life, found a new job, and reduced her online activities. DISCUSSION: Even though the patient's psychopathology stems from a disposition in terms of a personality disorder with histrionic and narcissistic features, excessive internet role play obviously functioned as a trigger to develop DIS. Conclusively, cyberspace's anonymous interactivity may offer the possibility to explore one's identity while also putting at risk its coherence.

The dissociative disorders. Rarely considered and underdiagnosed.

A wide variety of dissociative disorders, including dissociative amnesia, dissociative fugue, depersonalization disorder, dissociative identity disorder, and various forms of dissociative disorder not otherwise specified. In many instances, these disorders are either underdiagnosed or misdiagnosed secondary to the clinician's mistaken belief that dissociative disorders are rare. Recent research shows that dissociative disorders may comprise 5% to 10% of psychiatric populations. This article reviews the epidemiology and clinical symptomatology of these disorders. In addition, various screening and diagnostic instruments, such as the DES, Structured Clinical Interview for Dissociative Disorders, and MMPI, are discussed.

Psychiatrists' attitudes to multiple personality disorder: a questionnaire study.

OBJECTIVE: To assess the attitudes of a random sample of Canadian psychiatrists to Multiple Personality Disorder (MPD) and assess the relative prevalence of the condition in three comparable cities in Ontario. METHOD: A questionnaire was sent to all psychiatrists who were members of the Canadian Psychiatric Association and who were resident in Ottawa, Kingston and London. Questions were asked on the respondent's personal clinical experience of MPD and his/her attitude to this condition. Some personal and demographic questions were also included. RESULTS: 180 out of 294 questionnaires (61.2%) were returned. The existence of MPD was doubted by 27.8% of psychiatrists who responded to the questionnaire, with a significantly higher proportion in London than in Kingston or in Ottawa. A substantial majority in all three cities agreed that media publicity and the psychiatrist's own belief system affected the prevalence of MPD. CONCLUSION: These results confirm that there is a split in the profession regarding belief in the existence of MPD as a diagnosis.

Vicarious traumatization in the work with survivors of childhood trauma.

1. Persons working with victims of childhood trauma may experience traumatic countertransference and vicarious traumatization. After hearing a patient's trauma story, which is a necessary part of childhood trauma therapy, staff may experience post-traumatic stress disorder, imagery associated with the patient's story and the same disruptions in relationships as the patient. 2. During the first 6 months of working with survivors of childhood trauma, common behaviors of staff members were identified, including a lack of attention, poor work performance, medication errors, sick calls, treatment errors, irreverence, hypervigilance, and somatic complaints. 3. Staff working with victims of childhood trauma can obtain the necessary staff support through team support, in traumatic events, and in a leadership role.

On the belief that one body may be host to two or more personalities.

The belief in the validity of the multiple personality concept is discussed in this article. Two scaffolding constructions are analyzed: dissociation and repression. As generally employed, these constructions grant no agency to the multiple personality patient. The claim is made that the conduct of interest arises in discourse, usually with the therapist as the discourse partner. In reviewing the history of multiple personality and the writings of current advocates, it becomes clear that contemporary users of the multiple personality disorder diagnosis participate in a subculture with its own set of myths, one of which is the autonomous actions of mental faculties. Of special significance is the readiness to transfigure imaginings into rememberings of child abuse, leading ultimately to the manufacture of persons. The implications for both therapy and theory of regarding the patient as agent in place of the belief that the contranormative conduct is under the control of mentalistic faculties are discussed.

Adult reconstruction of childhood events in the multiple personality literature.

The author reviews the dependability of adult reports of childhood abuse and trauma, which are emerging in therapy with increasing frequency. He reviews the literature on multiple personality disorder to explore the extent to which corroboration of adult reports of childhood events is recorded. He also summarizes the relevant studies of memory both with and without the aid of hypnosis. He finds that there is minimal corroboration in the literature of the adults' reports of childhood abuse. Memories brought forth with the aid of hypnosis are undependable because of the large number of inaccuracies introduced by hypnotized subjects. Memories brought forth without hypnosis have been shown to be prone to distortion by intentional as well as by unwitting cues. The author concludes that the recent enthusiasm for the adult discovery of childhood abuse has been accompanied by little attention to factors that potentially affect recall of childhood abuse, including the bias of therapy. The use of hypnosis might well be an aggravating factor in distorted recollections of childhood abuse. Validation without corroboration by the therapist of the patient's memories has serious ethical and possibly legal consequences.

Four cases of supposed multiple personality disorder: evidence of unjustified diagnoses.

Four cases are presented in which an unjustified diagnosis of multiple personality disorder was made. These cases are used to illustrate the concern that some cases of multiple personality disorder may be the result of misdiagnosis by both patients and clinicians.