Dissociative Identity Disorder: A Review of Research From 2011 to 2021.

ABSTRACT: Dissociative identity disorder (DID) has historically been one of the most controversial topics in the study of psychopathology. Building on a previous review of empirical research on DID from 2000 to 2010, the present review examined DID research from 2011 to 2021. The research output included 56 case studies and 104 empirical studies. Within the empirical studies, approximately 1354 new cases of DID emerged, which resulted in an average samples of approximately 20. Reanalysis of previous samples was standard in the literature with only 40% of reported cases being new. Studies emerged from dozens of countries across the world, but the majority of cases were from Western counties, especially the United States. Diagnosis primarily relied upon validated measures, but 74% of all new cases came from six research groups. Overall, research on DID is steady but methodologically limited in ways that make generalization, especially about etiology, difficult.

[Dissociative identity disorder in adolescents: From self-diagnosis to transient illness]. / Trouble dissociatif de l'identité de l'adolescent : de l'autodiagnostic à la maladie transitoire.

The category of dissociative identity disorder (DID) has puzzled medical science and fascinated popular culture for almost 200 years. Its occurrence in young people raises at least two new questions addressed by science studies and embedded philosophy: self-diagnosis (related to cyberchondria and mass media-induced illness) and transient disease (related to looping effect and identity claim specific to adolescence). In an attempt to refine the sociocognitive model, we analyze the impact of these notions in understanding the local ecological niche in which contemporary adolescent DID occurs.

Caracterización de la patología dual en personas que buscan tratamiento de adicciones en centros ambulatorios mexicanos / Characterization of dual disorders in addiction treatment-seekers at mexican outpatient centers

INTRODUCCIÓN: En México son pocos los estudios publicados sobre la patología dual (PD) en centros de tratamiento espe­cializados que describan las necesidades reales de tratamiento y menos aún que se hayan realizado en centros de tratamiento de adicciones del sistema público. Por esto, el objetivo de pre­sente estudio fue analizar la PD y otras características clínicas en personas que buscan tratamiento en centros ambulatorios de adicciones del sistema público. MÉTODO: Estudio transversal multisede. Se analizó una muestra de 148 pacientes de cen­tros de tratamiento. Se evaluaron trastornos psiquiátricos con la Mini Entrevista Neuropsiquiátrica Internacional, conductas sexuales de riesgo con la Escala de Comportamiento de Riesgo de VIH, consumo de drogas inyectables, y la calidad de vida con el Cuestionario de Calidad de Vida. Se realizaron análisis univariados mediante chi cuadrado para determinar diferen­cias estadísticas entre personas con y sin PD, así como regre­sión lineal para calidad de vida y regresión logística binomial para determinar el riesgo para presentar consumo de drogas inyectables, uso de condón y conducta suicida. RESULTADOS: La cocaína fue la droga de impacto con mayor prevalencia (33.8%). El grupo de personas con trastorno por consumo de alcohol + trastorno por consumo de drogas presentó mayor comorbilidad con el trastorno depresivo mayor (25.7%), tras­torno antisocial (27.7%), déficit de atención (11.5%) e intento suicida (17.6%). El grupo con PD presentó mayor consumo de drogas inyectables (OR= 1.67), no uso de condón con pareja primaria (OR= 3.66), más intentos de suicidio (OR= 4.2) y una menor calidad de vida en comparación con aquellos sin PD. CONCLUSIÓN: Caracterizar a los pacientes con PD, permite iden­tificar con precisión sus necesidades de tratamiento y desarro­llar programas de mejora continua para optimizar los recursos y mejorar el éxito de la atención

INTRODUCTION: In Mexico, very few studies have been published on dual disorders (DD) at specialized treatment centers describing actual treatment needs and even few­er have been undertaken at addiction treatment centers in the public system. The objective of this study was therefore to analyze DD and other clinical characteristics in people seeking treatment at outpatient addiction centers in the public system. Method. Cross-sectional multi-site study. A sample of 148 patients from treatment centers was analyzed. Psychi­atric disorders were evaluated with the Mini International Neuropsychiatric Interview, risky sexual behaviors with the HIV Risk Behavior Scale, injection drug use, and quality of life with the Quality of Life Questionnaire. Univariate chi-square analyses were performed to determine statistical dif­ferences between subjects with and without DD, while linear regression was used to calculate quality of life and binomial logistic regression to determine the risk of injection drug use, condom use, and suicidal behavior. RESULTS: Cocaine was the impact drug with the highest prevalence (33.8%). The group of subjects with alcohol use disorder + drug use disorder presented greater comorbidi­ty with major depressive disorder (25.7%), antisocial disor­der (27.7%), attention deficit (11.5%) and suicide attempt (17.6%). The group with DD presented higher injection drug use (OR = 1.67), non-use of condoms with a primary part­ner (OR = 3.66), more suicide attempts (OR = 4.2) and lower quality of life than those without DD. CONCLUSION: Characterizing patients with DD enables the accurate identification of their treatment needs and the development of continuous improvement programs to opti­mize resources and improve the success of care

Dissociative identity disorder: out of the shadows at last?

Dissociative identity disorder (DID) is a severely debilitating disorder. Despite recognition in the current and past versions of the DSM, DID remains a controversial psychiatric disorder, which hampers its diagnosis and treatment. Neurobiological evidence regarding the aetiology of DID supports clinical observations that it is a severe form of post-traumatic stress disorder.

"Yo soy tres". A propósito de un caso de trastorno de identidad disociativo / "I am three". A case of dissociative identity disorder

Objetivo. Actualización del trastorno de identidad disociativo a través de la presentación de un caso y la revisión teórica del concepto. Caso clínico. Varón de 17 años internado en Unidad de Agudos por intento autolítico que a lo largo del ingreso manifiesta la coexistencia de tres identidades subjetivas de manera alterna, junto a episodios de alteración de la memoria e inestabilidad emocional. Resultados. Tanto las entrevistas clínicas como la evolución del caso confirman la existencia de un trastorno de identidad disociativo con una base traumática en relación con acontecimientos altamente estresantes en la primera infancia y un establecimiento patológico del apego con los cuidadores principales. Conclusiones. El trastorno de identidad disociativo es una psicopatología compleja caracterizada por alteraciones en la memoria e identidad. Resulta interesante considerar la prevalencia de patología de tipo disociativo en unidades de hospitalización de adolescentes, en su gran mayoría vinculadas a experiencias traumáticas tempranas

Objective. To present an update on dissociative identity disorder through the presentation of a case and a theoretical review of the concept. Clinical case. A 17-year-old male admitted to the Acute Unit due to a suicide attempt, that during his admission manifested the coexistence of three subjective identities alternately, together with episodes of memory alteration and emotional instability. Results. Both the clinical interviews and the evolution of the case confirm the existence of a Dissociative Identity Disorder with a traumatic basis in relation to highly stressful events in early childhood and a pathological establishment of attachment with the main caregivers. Conclusions. Dissociative identity disorder is a complex psychopathology characterised by alterations in memory and identity. It is of interest to consider the prevalence of dissociative pathology in adolescent hospitalisation units, most of them linked to early traumatic experiences

Neurodevelopmental origins of abnormal cortical morphology in dissociative identity disorder.

OBJECTIVE: To examine the two constitutes of cortical volume (CV), that is, cortical thickness (CT) and surface area (SA), in individuals with dissociative identity disorder (DID) with the view of gaining important novel insights into the underlying neurobiological mechanisms mediating DID. METHODS: This study included 32 female patients with DID and 43 matched healthy controls. Between-group differences in CV, thickness, and SA, the degree of spatial overlap between differences in CT and SA, and their relative contribution to differences in regional CV were assessed using a novel spatially unbiased vertex-wise approach. Whole-brain correlation analyses were performed between measures of cortical anatomy and dissociative symptoms and traumatization. RESULTS: Individuals with DID differed from controls in CV, CT, and SA, with significantly decreased CT in the insula, anterior cingulate, and parietal regions and reduced cortical SA in temporal and orbitofrontal cortices. Abnormalities in CT and SA shared only about 3% of all significantly different cerebral surface locations and involved distinct contributions to the abnormality of CV in DID. Significant negative associations between abnormal brain morphology (SA and CV) and dissociative symptoms and early childhood traumatization (0 and 3 years of age) were found. CONCLUSIONS: In DID, neuroanatomical areas with decreased CT and SA are in different locations in the brain. As CT and SA have distinct genetic and developmental origins, our findings may indicate that different neurobiological mechanisms and environmental factors impact on cortical morphology in DID, such as early childhood traumatization.

The Psychobiology of Authentic and Simulated Dissociative Personality States: The Full Monty.

The etiology of dissociative identity disorder (DID) remains a topic of debate. Proponents of the fantasy model and the trauma model of DID have both called for more empirical research. To this end, the current study presents new and extended data analyses of a previously published H2O positron emission tomography imaging study. This study included 29 subjects: 11 patients with DID and 10 high- and 8 low-fantasy-prone DID-simulating mentally healthy control subjects. All subjects underwent an autobiographical memory script-driven (neutral and trauma related) imagery paradigm in 2 (simulated) dissociative personality states (neutral and trauma related). Psychobiological and psychophysiological data were obtained. Results of the new post-hoc tests on the psychophysiological responses support the trauma model. New results of the brain imaging data did not support the fantasy model. This study extends previously published results by offering important new supporting data for the trauma model of DID.

Similar cortical but not subcortical gray matter abnormalities in women with posttraumatic stress disorder with versus without dissociative identity disorder.

Neuroanatomical evidence on the relationship between posttraumatic stress disorder (PTSD) and dissociative disorders is still lacking. We acquired brain structural magnetic resonance imaging (MRI) scans from 17 patients with dissociative identity disorder (DID) and co-morbid PTSD (DID-PTSD) and 16 patients with PTSD but without DID (PTSD-only), and 32 healthy controls (HC), and compared their whole-brain cortical and subcortical gray matter (GM) morphological measurements. Associations between GM measurements and severity of dissociative and depersonalization/derealization symptoms or lifetime traumatizing events were evaluated in the patient groups. DID-PTSD and PTSD-only patients, compared with HC, had similarly smaller cortical GM volumes of the whole brain and of frontal, temporal and insular cortices. DID-PTSD patients additionally showed smaller hippocampal and larger pallidum volumes relative to HC, and larger putamen and pallidum volumes relative to PTSD-only. Severity of lifetime traumatizing events and volume of the hippocampus were negatively correlated. Severity of dissociative and depersonalization/derealization symptoms correlated positively with volume of the putamen and pallidum, and negatively with volume of the inferior parietal cortex. Shared abnormal brain structures in DID-PTSD and PTSD-only, small hippocampal volume in DID-PTSD, more severe lifetime traumatizing events in DID-PTSD compared with PTSD-only, and negative correlations between lifetime traumatizing events and hippocampal volume suggest a trauma-related etiology for DID. Our results provide neurobiological evidence for the side-by-side nosological classification of PTSD and DID in the DSM-5.

High psychiatric comorbidity in adolescents with dissociative disorders.

AIM: The aim of this study was to evaluate psychiatric comorbidity rates and patterns in a sample of clinically referred adolescents diagnosed with dissociative disorders (DD) by using a structured interview. METHODS: All participants completed a comprehensive test battery, which consisted of a questionnaire for sociodemographic data and clinical history, Child Posttraumatic Stress Reaction Index, Childhood Abuse and Neglect Questionnaire and the Adolescent Dissociative Experiences Scale. Diagnosis was made by the Structured Clinical Interview for DSM-IV Dissociative Disorders. Psychiatric comorbidity was assessed using the Schedule for Affective Disorders and Schizophrenia for School Age Children - Present and Lifetime Version. RESULTS: A total of 25 adolescent subjects aged 12-18 years participated in the study. Ten adolescents were diagnosed as having dissociative identity disorder and 15 of them were diagnosed as having dissociative disorder-not otherwise specified based on the Structured Clinical Interview for DSM-IV Dissociative Disorders findings. Adolescents with dissociative identity disorder were found to have higher scores on the Adolescent Dissociative Experiences Scale and Child Posttraumatic Stress Reaction Index than the dissociative disorder-not otherwise specified group. Sexual and physical abuses were also found to be among the main traumatic events. Incest was reported in six cases of the study sample. All subjects had at least one comorbid psychiatric disorder. The most common psychiatric diagnoses were major depressive disorder (n = 25; 100%) and post-traumatic stress disorder (n = 22; 88%). CONCLUSION: High psychiatric comorbidity rates were found in adolescents diagnosed with DD. A prevalent history of abuse and traumatic events was represented. Clinicians should be aware of the impacts of DD on adolescents' mental health.

Dissociative identity disorder: An empirical overview.

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.

A review of published research on adult dissociative identity disorder: 2000-2010.

The purpose of this study was to assess the scientific and etiological status of dissociative identity disorder (DID) by examining cases published from 2000 to 2010. In terms of scientific status, DID is a small but ongoing field of study. The review yielded 21 case studies and 80 empirical studies, presenting data on 1171 new cases of DID. A mean of 9 articles, each containing a mean of 17 new cases of DID, emerged each year. In terms of etiological status, many of the central criticisms of the disorder's validity remain unaddressed. Most cases of DID emerged from a small number of countries and clinicians. In addition, documented cases occurring outside treatment were almost nonexistent. Finally, people simulating DID in the laboratory were mostly indistinguishable from individuals with DID. Overall, DID is still a topic of study, but the research lacks the productivity and focus needed to resolve ongoing controversies surrounding the disorder.

Stockholm syndrome manifestation of Munchausen: an eye-catching misnomer.

A young woman hospitalized herself for a picture resembling Stockholm syndrome (becoming a willing captive in a cult, sympathetic to the leader). After a short period of time, it became clear that she had used a false identity and had invented the story, leading to diagnoses of both Munchausen syndrome and dissociative identity disorder. Despite a long period of treatment, she eventually suicided. The authors examine the coexistence of these two unusual disorders and their possible shared etiologies in this complex case.

Possession experiences in dissociative identity disorder: a preliminary study.

Dissociative trance disorder, which includes possession experiences, was introduced as a provisional diagnosis requiring further study in the Diagnostic and Statistical Manual of Mental Disorders (4th ed.). Consideration is now being given to including possession experiences within dissociative identity disorder (DID) in the Diagnostic and Statistical Manual of Mental Disorders (5th ed.), which is due to be published in 2013. In order to provide empirical data relevant to the relationship between DID and possession states, I analyzed data on the prevalence of trance, possession states, sleepwalking, and paranormal experiences in 3 large samples: patients with DID from North America; psychiatric outpatients from Shanghai, China; and a general population sample from Winnipeg, Canada. Trance, sleepwalking, paranormal, and possession experiences were much more common in the DID patients than in the 2 comparison samples. The study is preliminary and exploratory in nature because the samples were not matched in any way.

Axis-I comorbidity in female patients with dissociative identity disorder and dissociative identity disorder not otherwise specified.

The aim of this study was to investigate axis-I comorbidity in patients with dissociative identity disorder (DID) and dissociative disorder not otherwise specified (DDNOS). Using the Diagnostic Interview for Psychiatric Disorders, results from patients with DID (n = 44) and DDNOS (n = 22) were compared with those of patients with posttraumatic stress disorder (PTSD) (n = 13), other anxiety disorders (n = 14), depression (n = 17), and nonclinical controls (n = 30). No comorbid disorders were found in nonclinical controls. The average number of comorbid disorders in patients with depression or anxiety was 0 to 2. Patients with dissociative disorders averagely suffered from 5 comorbid disorders. The most prevalent comorbidity in DDNOS and DID was PTSD. Comorbidity profiles of patients with DID and DDNOS were very similar to those in PTSD (high prevalence of anxiety, somatoform disorders, and depression), but differed significantly from those of patients with depression and anxiety disorders. These findings confirm the hypothesis that PTSD, DID, and DDNOS are phenomenologically related syndromes that should be summarized within a new diagnostic category.

Assessing short-term individual consistency using IRT-based statistics

Se propone un procedimiento, basado en un estadístico global para evaluar la consistencia intra-individual en un diseño retest basado en un intervalo de retest corto. El procedimiento se desarrolla en el marco de los modelos paramétricos de TRI, y el estadístico, que se basa en la función de verosimilitud, puede ser considerado como una extensión del estadístico lz. Se discute la justificación para el uso e interpretación del estadístico y se propone además un estadístico estandarizado a nivel de ítem para obtener claves acerca de las posibles causas de la inconsistencia detectada mediante el índice global. El procedimiento se ilustra con un ejemplo real y una simulación paralela en el dominio de la personalidad(AU)

This article proposes a procedure, based on a global statistic, for assessing intra-individual consistency in a test-retest design with a short-term retest interval. The procedure is developed within the framework of parametric item response theory, and the statistic is a likelihood-based measure that can be considered as an extension of the well-known lz person-fit index. The rationale for using and interpreting the proposed statistic is discussed, and an adapted standardized residual at the item level is also proposed to obtain clues about the possible causes of the detected inconsistency. The procedure is illustrated with a real-data example and a parallel simulation in the personality domain(AU)

Paraphilia from a dissociative perspective.

A dissociative structural model of the psyche can account for a wide range of symptoms across many DSM-IV categories, including sexual compulsions and addictions. The model leads to a distinct overall plan of treatment and a set of operationalized interventions aimed at integration of the self, rather than suppression of impulses. The model could be tested first in epidemiological studies and later in treatment outcome studies.

[Gender differences in dissociative disorders]. / Geschlechtsunterschiede bei dissoziativen Störungen.

The relationship between mental illness, on the one hand, and sex and gender, on the other hand, has received interest since the beginning of medicine in antique times. A prototypical example of a seemingly woman-specific disease is hysteria. The term itself, which is derived from the Greek word for womb, denotes a psychosexual dimension comprising the current attitude towards sexuality and the dominating gender relationship. In addition, the colourful history of hysteria indicates that illness is not exclusively determined by biological factors, but also significantly by socio-cultural influences, for example in the treatment of hysterical women. Even nowadays, there is a wide-spread belief that dissociative symptoms and disorders, which have succeeded hysteria in current classification systems, are predominantly seen in women. However, empirical studies in the general population and in different clinical samples using sound instruments have indicated that dissociative symptoms do not differ between the genders. The seemingly dominance of dissociative disorders in women may also depend on the socio-cultural context, because men with dissociative disorders usually do not enter the general health system, but rather the legal system, i.e. they can be found in jail or forensic institutions.

Frontal and occipital perfusion changes in dissociative identity disorder.

The aim of the study was to investigate if there were any characteristics of regional cerebral blood flow (rCBF) in dissociative identity disorder. Twenty-one drug-free patients with dissociative identity disorder and nine healthy volunteers participated in the study. In addition to a clinical evaluation, dissociative psychopathology was assessed using the Structured Clinical Interview for DSM-IV Dissociative Disorders, the Dissociative Experiences Scale and the Clinician-Administered Dissociative States Scale. A semi-structured interview for borderline personality disorder, the Hamilton Depression Rating Scale, and the Childhood Trauma Questionnaire were also administered to all patients. Normal controls had to be without a history of childhood trauma and without any depressive or dissociative disorder. Regional cerebral blood flow (rCBF) was studied with single photon emission computed tomography (SPECT) with Tc99m-hexamethylpropylenamine (HMPAO) as a tracer. Compared with findings in the control group, the rCBF ratio was decreased among patients with dissociative identity disorder in the orbitofrontal region bilaterally. It was increased in median and superior frontal regions and occipital regions bilaterally. There was no significant correlation between rCBF ratios of the regions of interest and any of the psychopathology scale scores. An explanation for the neurophysiology of dissociative psychopathology has to invoke a comprehensive model of interaction between anterior and posterior brain regions.

Surrealismo y locura (parte I) / Madness and surrealism (part I)

Nuestra pretensión en este trabajo ha consistido en abordar las relaciones entre surrealismo y psiquiatría. Tales relaciones son posibles dado que este grupo de artistas y literator: a) mostraron un gran interés por lo irracional y por la locura; b) algunos de ellos fueron psiquiatras (Breton, Huelsenbeck) o tenían importantes conocimientos de algunas patologías que se explican en nuestra especialidad; y c) adoptaron como matriz ideológica los postulados psicoanalíticos. Dentro de este movimiento, consideramos a Dalí no sólo como un pintor, sino también como un hombre cultivado y bastante versado en el tema de la paranoia. El encuentro que Lacan tuvo con el genio de Cadaqués fue fundamental para que el primero de ellos desarrollara un conocimiento distinto sobre este trastorno y, como consecuencia, defendiese brillantemente su tesis doctoral en 1932, que fue elogiada por la vanguardia artística y a partir de ese momento, fue considerado como el guía y maestro del futuro movimiento psicoanalítico francés

The purpose of this work is to study the relationship between surrealism and psychiatry. This is possible because these group of artist and arts men: a) took an interest in the irrational and madness; b) some of them were psychiatrist (Breton, Huelsenbeck) or had a through knowledge of some psychopathology; and c) they adopted psychoanalytical propositions as ideology. Within this movement we consider Dalí not only as a painter but also a cultured and expert man in th e theme of paranoia. The meeting between Lacan and the artist from Cadaqués was decisive for the first of them to develop a different concept to paranoia that in 1932 ended up a brilliant doctoral thesis which was praised by the ultra-modern artist, and from then on the future French psychoanalytical movement

Trauma and dissociation in China.

OBJECTIVE: In order to determine whether pathological dissociation occurs in China, the authors conducted a survey among psychiatric inpatients, outpatients, and the general population in Shanghai, China. There is virtually no popular or professional knowledge of dissociative identity disorder in China, and therefore professional and popular contamination cannot exist. METHOD: Chinese versions of the Dissociative Experiences Scale and the Dissociative Disorders Interview Schedule were administered to 423 inpatients, 304 outpatients, and 618 factory workers in Shanghai by Chinese psychiatrists working at the Shanghai Mental Health Center. RESULTS: Dissociative disorders were diagnosed in 24 respondents by structured interview, and 15 respondents fell into the dissociative taxon on the Dissociative Experiences Scale. The outpatients reported the highest rates of childhood physical and/or sexual abuse and of pathological dissociation. CONCLUSIONS: Pathological dissociation can be detected readily among psychiatric outpatients in China but is much less common in the general population. Pathological dissociation is more frequent in more traumatized subsamples of the Chinese population. The findings are not consistent with the sociocognitive, contamination, or iatrogenic models of dissociative identity disorder.