Empathic Resonance: A Case of Dissociative Identity Disorder (DID)

Dissociative identity disorder (DID) also referred as multiple personality disorder can be accompanied by related alterations in affect, behavior and sensory-motor functioning. This article describes the case of a 33-year-old woman with a diagnostic of DID and who required intensive treatment, who suffered bullying at the age of 15 with a demon personality. Despite psychopharmacological treatment there was no improvement until the emphatic resonance therapy was carried out. Our case report shows the complexity of providing treatment for patient with DID (AU)

[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.

How do Patients Diagnosed with Dissociative Identity Disorder Experience Conflict? A Qualitative Study.

The role and nature of conflict in the development and manifestation of dissociative identity disorder (DID) remains underexplored beyond theoretical deduction. In this qualitative instrumental case study, we explored the subjective experience and nature of conflict in a group of adult psychiatric patients diagnosed with DID. We purposively selected typed transcriptions of 28 previously recorded in-depth individual interviews with 15 patients, their audio recordings and associated field notes. The data were thematically analyzed and constant comparison was applied. Two main themes emerged from the transcriptions, namely, participants' experiences of having one or more incompatible and conflicting worldviews about their DID, and the type and nature of conflict that arises between dissociative identities, i.e., conflict of information in awareness, conflicting actions or behaviors, conflicting emotions, conflicting goals, conflicting values, and a battle of wills. Patients with DID have contextually and culturally variable comprehension of the origin of their DID. Conflict between dissociative identities was pervasive, multifaceted, and exacerbated by a lack of awareness between identities. The study provides insight into the complexities of conflict between dissociative identities, as well as highlights the role of inter-identity awareness in conflict.

How Does It Feel to Have a Disturbed Identity? The Phenomenology of Identity Diffusion in Patients With Borderline Personality Disorder: A Qualitative Study.

Identity diffusion is one of the defining characteristics of borderline personality disorder (BPD). Given its central importance in the formal diagnostic criteria for personality disorders, identity diffusion is remarkably under-researched. In particular, our knowledge of the phenomenology of identity diffusion needs to be improved. This study is based on semistructured interviews with 16 younger women SCID-5-diagnosed with BPD. All interviews were analyzed using the interpretative phenomenological analysis approach. On the basis of this analysis, the patients' descriptions of how identity diffusion manifests itself in their subjective experience are classified into nine categories: disintegrated self-image; using various façades to stabilize the self; painful feelings of the self as broken; feeling that the self does not fit in; inner emptiness; "I don't know what I want"; great need for attention from others to stabilize identity; feeling unable to handle interpersonal relationships; and using sex to distract the self and regulate painful self-states.

Inter-identity amnesia for neutral episodic self-referential and autobiographical memory in Dissociative Identity Disorder: An assessment of recall and recognition.

Amnesia is a core diagnostic criterion for Dissociative Identity Disorder (DID), however previous research has indicated memory transfer. As DID has been conceptualised as being a disorder of distinct identities, in this experiment, behavioral tasks were used to assess the nature of amnesia for episodic 1) self-referential and 2) autobiographical memories across identities. Nineteen DID participants, 16 DID simulators, 21 partial information, and 20 full information comparison participants from the general population were recruited. In the first study, participants were presented with two vignettes (DID and simulator participants received one in each of two identities) and asked to imagine themselves in the situations outlined. The second study used a similar methodology but with tasks assessing autobiographical experience. Subjectively, all DID participants reported amnesia for events that occurred in the other identity. On free recall and recognition tasks they presented a memory profile of amnesia similar to simulators instructed to feign amnesia and partial information comparisons. Yet, on tests of recognition, DID participants recognized significantly more of the event that occurred in another identity than simulator and partial information comparisons. As such, results indicate that the DID performance profile was not accounted for by true or feigned amnesia, lending support to the idea that reported amnesia may be more of a perceived than actual memory impairment.

Hypnotizability and the Natural Human Ability to Alter Experience.

There seems to be a natural, human ability to alter one's experience that already exists - prior to and apart from any hypnotic induction. Individual differences in this ability range from low to high and are largely commensurate with the person's assessed hypnotizability. More importantly, these preexisting, individual differences in the ability to alter experience seem to be the "substrate" that enables each individual's response to hypnotic suggestions. It is proposed that, with some notable exceptions, the hypnosis field's understanding of hypnotizability has been hindered by theorists' (and clinicians') tendency to consider the instruments that reveal hypnotic phenomena (i.e., hypnosis and suggestions) to be explanatory concepts.

Psychometric properties of the Personality Inventory for DSM-5 (PID-5) in brazilian samples / Propriedades psicométricas do Personality Inventory for DSM-5 (PID-5) em amostras brasileiras / Propiedades psicométricas del Personality Inventory for DSM-5 (PID-5) en muestras brasileñas

This study aimed to investigate the psychometric properties of the Personality Inventory for DSM-5 (PID-5) in Brazilian community and clinical samples. This research included 1,210 people, 554 of them with psychopathology indicators. The participants answered the PID-5 and the Self-Reporting Questionnaire, in addition to a sociodemographic and health data questionnaire that included the six items of the suicidality module of the Mini International Neuropsychiatric Interview. The results showed that the 25 facets of the PID-5 had adequate reliability coefficients and evidence of unidimensionality. The instrument's five-factor structure was replicated with high levels of congruence with the representative sample from North America. PID-5 scores were statistically different between clinical and community groups and were positively correlated with measures of suicide risk and psychopathological symptoms. This study presents the psychometric properties of PID-5 and its suitability for use in the Brazilian population (AU).

Este estudo teve como objetivo investigar as propriedades psicométricas do Inventário de Personalidade para o DSM-5 (PID-5) para amostras clínica e comunitária brasileiras. Esta pesquisa incluiu 1.210 pessoas, sendo 554 delas com indicadores de psicopatologia. Os participantes responderam ao PID-5 e ao Self-Reporting Questionnaire, além de um questionário sobre dados sociodemográfico e de saúde que incluía os seis itens do módulo de risco de suicídio Mini International Neuropsychiatric Interview. Os resultados mostraram que as 25 facetas do PID-5 apresentaram coeficientes de confiabilidade adequados e evidências de unidimensionalidade. A estrutura de cinco fatores do instrumento foi replicada com altos níveis de congruência com a amostra representativa da América do Norte. Os escores PID-5 foram estatisticamente diferentes entre os grupos clínicos e comunitários e foram positivamente correlacionados com medidas de risco de suicídio e sintomas psicopatológicos. Este estudo apresenta as propriedades psicométricas do PID-5 e sua adequação para uso na população brasileira (AU).

Este estudio tuvo como objetivo investigar las propiedades psicométricas del Inventario de Personalidad para el DSM-5 (PID-5) en muestras clínicas y comunitarias de Brasil. Esta investigación incluyó a 1.210 personas, 554 de ellas con indicadores de psicopatología. Los participantes respondieron al PID-5 y al Self-Reporting Questionnaire, además de un cuestionario de datos sociodemográficos y de salud que incluía los seis ítems del módulo de suicidio de la Mini Entrevista Neuropsiquiátrica Internacional. Los resultados mostraron que las 25 facetas del PID-5 presentaron coeficientes de confiabilidad adecuados y evidencias de unidimensionalidad. La estructura de cinco factores del instrumento se replicó con altos niveles de congruencia con la muestra representativa de Norteamérica. Las puntuaciones de PID-5 fueron estadísticamente diferentes entre los grupos clínicos y comunitarios, y se correlacionaron positivamente con las medidas de riesgo de suicidio y síntomas psicopatológicos. Este estudio presenta las propiedades psicométricas del PID-5 y su idoneidad para su uso en la población brasileña (AU).

Voices: Are They Dissociative or Psychotic?

Auditory hallucinations are widely regarded as symptoms of brain disease treated with medications. In an alternative paradigm, voices are understood as trauma-driven dissociated, disowned, or disavowed aspects of self; the goal is not to suppress them but to integrate them during psychotherapy. Auditory hallucinations are common in dissociative identity disorder, borderline personality disorder, and complex posttraumatic stress disorder and are not specific to psychosis. The features that differentiate psychotic from dissociative voices include the qualities of the voices themselves, as well as other symptoms: for example, compared with dissociative voices, psychotic voices are accompanied by less sociability, more formal thought disorder, more negative symptoms including blunted affect, and more delusions. The author proposes that the psychotherapy of dissociative voices can be indicated trans-diagnostically, including in a subgroup of individuals with diagnoses of schizophrenia. Psychotherapeutic strategies are illustrated with a case example.

Seeking double personality: Nakamura Kokyo's work in abnormal psychology in early 20th-century Japan.

This paper examines Nakamura Kokyo's study of a woman with a split personality who lived in his home as a maid from 1917 until her death in 1940. She was his indispensable muse and assistant in his efforts to promote abnormal psychology and psychotherapy. This paper first explores the central position of multiple personality in Nakamura's theory of the subconscious, which was largely based on the model of dissociation. It then examines how it became a central issue in Nakamura's disputes with religions including the element of spirit possession, which invoked Western psychical research to modernize their doctrines. While both were concerned with the subconscious and alterations in personality, Nakamura's psychological view was distinguished from those spiritual understandings by his emphasis on individual memories, particularly those that were traumatic, and hysteria. The remaining sections of the paper will examine Nakamura's views on memory and hysteria, which conflicted with both the academic mainstream and the established cultural beliefs. This conflict may partly explain the limited success of Nakamura's academic and social campaigns.

Preliminary Evidence of a Missing Self Bias in Face Perception for Individuals with Dissociative Identity Disorder.

Failing to recognize one's mirror image can signal an abnormality in one's sense of self. In dissociative identity disorder (DID), individuals often report that their mirror image can feel unfamiliar or distorted. They also experience some of their own thoughts, emotions, and bodily sensations as if they are nonautobiographical and sometimes as if instead, they belong to someone else. To assess these experiences, we designed a novel backwards masking paradigm in which participants were covertly shown their own face, masked by a stranger's face. Participants rated feelings of familiarity associated with the strangers' faces. 21 control participants without trauma-generated dissociation rated masks, which were covertly preceded by their own face, as more familiar compared to masks preceded by a stranger's face. In contrast, across two samples, 28 individuals with DID and similar clinical presentations (DSM-IV Dissociative Disorder Not Otherwise Specified type 1) did not show increased familiarity ratings to their own masked face. However, their familiarity ratings interacted with self-reported identity state integration. Individuals with higher levels of identity state integration had response patterns similar to control participants. These data provide empirical evidence of aberrant self-referential processing in DID/DDNOS and suggest this is restored with identity state integration.

Rorschach Assessment of Two Distinctive Personality States of a Person With Dissociative Identity Disorder.

This case study used test data from a patient with Dissociative Identity Disorder (DID; American Psychiatric Association, 2013 ) to illustrate how two main personality states of the patient ("Ann" and "Ben") seemed to function. The Rorschach Performance Assessment System (R-PAS; Meyer, Viglione, Mihura, Erard, & Erdberg, 2011 ) and the Inventory of Interpersonal Problems-Circumplex (IIP-64; Horowitz, Alden, Wiggins, & Pincus, 2000 ), administered to Ann and Ben in separate settings, exposed two diverse R-PAS and IIP-64 profiles. Ann's R-PAS profile suggested an intellectualized style of information processing with few indications of psychological problems. Ben's profile indicated severe perceptual, cognitive, and interpersonal difficulties combined with suspicion and anxiety. Ann's IIP-64 profile suggested minor interpersonal problems, whereas Ben's indicated serious relational difficulties. The findings were discussed in relation to the theory of trauma-related structural dissociation of the personality (van der Hart, Nijenhuis, & Steele, 2006 ), which implies an enduring split in the organization of the personality with more or less separate entities with their own sense of self, perception of the world, and ways of organizing emotional, cognitive, and social functions. The DID personality structure is seen as a defense strategy and as a pathway in the personality development producing serious psychological pain and symptoms.

¿Qué es el superyó? / Qu’est-ce que le Surmoi? / What is the superego?

El autor, partiendo de la tradición empírica británica, recela del concepto freudiano del superyó como entidad y, sin embargo, considera incuestionable su existencia como fenómeno para dar cuenta de toda una serie de manifestaciones clínicas en la práctica analítica. En ese sentido, la necesidad de castigo en psicosis y psiconeurosis, elementos persecutorios en las paranoias, autodenigración en la melancolía, rituales obsesivo-compulsivos, le parecen solamente entendibles desde la existencia del mencionado superyó. Va estudiando detenidamente cómo surge el concepto primero del ideal del yo y luego del superyó; cómo el yo se diferencia del ello y el superyó del yo; cómo resultan fundamentales las identificaciones con la figura parental frustrante dentro de la triangulación edípica, pero también con la figura parental amada, con la que se van produciendo diversas pérdidas parciales. Finalmente, se pregunta por el motivo de que el superyó sea fundamentalmente inconsciente. Siendo el agente represor, no puede ser reprimido: postula que en parte sea arrastrado al inconsciente por su proximidad a lo reprimido; pero, sobre todo, propone que el superyó se desgaje del yo por disociación, como algunas de las personalidades lo harían en las supuestas personalidades múltiples. (AU)

Building on the British empirical tradition, the author is wary of the Freudian conception of the superego as a clinical entity, although considers it unquestionably a phenomenon that accounts for a wide range of clinical manifestations in analytic practice. He argues that the need for punishment in psychosis and psychneurosis, persecutory elements in paranoia, self-denigration in melancholy and obsessive-compulsive rituals may only be understood in relation to the existence of a superego thus conceptualized. He examines how the concept of ego ideal emerges first, followed by the superego; how the ego distinguishes itself from the id, and the superego from the ego; how identification with the frustrating parent is essential to oedipal triangulation, but also with the loved parent, with whom various partial losses occur. Finally, he questions the fundamentally unconscious nature of the superego. As the repressing agent, it cannot be repressed. As such he postulates that, partly, the superego succumbs to the unconscious owing to its proximity to the repressed; but primarily the superego is split off from the ego through dissociation, as in the case of multiple personality. (AU)

L’auteur, partant de la tradition empirique britannique, se méfie du concept freudien du surmoi comme entité, mais il considère cependant qu’il est impossible de remettre en question son existence en tant que phénomène qui rend compte de toute une série de manifestations cliniques dans la pratique clinique. Dans ce sens, le besoin de punition dans la psychose et la psychonévrose, les éléments de persécution dans les paranoïas, l’autodénigrement dans la mélancolie, les rituels obsessionnels et compulsifs lui semblent ne pouvoir être compris qu’à travers l’existence du surmoi. Il étudie en détail comment surgit le concept tout d’abord d’idéal du moi puis ensuite de surmoi; comment le moi se différencie du ça et le surmoi du moi; combien les identifications avec la figure parentale frustrante sont fondamentales dans la triangulation œdipienne, mais également avec la figure aimée, avec laquelle se produisent progressivement diverses pertes partielles. Finalement, il se pose la question de savoir pourquoi le surmoi est fondamentalement inconscient. Etant l’agent du refoulement, il ne peut pas être refoulé: il propose qu’il est en partie poussé vers l’inconscient de par sa proximité au refoulé; mais surtout, il propose que le surmoi se détache du moi par dissociation, telles que certaines personnalités le feraient dans les personnalités multiples supposées. (AU)

¿Quiénes soy?, ¿quién somos? Identidades múltiples en el trabajo: un estado de la cuestión / Who are i? Who are we? A state-of-the-art review of multiple identities at work

El objetivo de este artículo es presentar una revisión del estado de la investigación y la práctica profesional acerca del papel desempeñado por las identidades múltiples individuales y sobre los procesos implicados en las múltiples identidades organizacionales, así como las consecuencias de ambos tipos de identidades para los individuos y las organizaciones. El artículo concluye con una serie de implicaciones prácticas y de líneas futuras de investigación y de intervención en relación con ambos fenómenos

The aim of this paper is to present a state-of-the-art review of research and professional practice regarding the role played by multiple individual identities and the processes involved in multiple organizational identities, as well as the consequences of both types of identities for individuals and organizations. The paper concludes by highlighting practical implications and proposals for future research and intervention related to both phenomena

Psychiatric Impact of Organized and Ritual Child Sexual Abuse: Cross-Sectional Findings from Individuals Who Report Being Victimized.

Organized and ritual child sexual abuse (ORA) is often rooted in the child's own family. Empirical evidence on possible associations between ORA and trauma-related symptoms in those who report this kind of extreme and prolonged violence is rare. The aim of our study was to explore socio-demographic and clinical characteristics of the individuals reporting ORA experiences, and to investigate protective as well as promotive factors in the link between ORA and trauma-related symptom severity. Within the framework of a project of the Independent Inquiry into Child Sexual Abuse in Germany, we recruited 165 adults who identified themselves as ORA victims via abuse- and trauma-specific networks and mailing lists, and they completed an anonymous online survey. We used variance analyses to examine correlations between several variables in the ORA context and PTSD symptoms (PCL-5) as well as somatoform dissociation (SDQ-5). Results revealed a high psychic strain combined with an adverse health care situation in individuals who report experiences with ORA. Ideological strategies used by perpetrators as well as Dissociative Identity Disorders experienced by those affected are associated with more severe symptoms (η²p = 0.11; η²p = 0.15), while an exit out of the ORA structures is associated with milder symptoms (η²p = 0.11). Efforts are needed to improve health care services for individuals who experience severe and complex psychiatric disorders due to ORA in their childhood.

Transfer of episodic self-referential memory across amnesic identities in dissociative identity disorder using the Autobiographical Implicit Association Test.

Individuals with dissociative identity disorder (DID) often report having no access to autobiographical experiences encoded by other identities. This research used the autobiographical Implicit Association Test (aIAT) to determine whether there was transfer of episodic self-referential memory events across amnesic identities. Nineteen DID individuals, 16 DID simulators, and 41 comparison participants (divided into amnesic and nonamnesic groups) engaged with an audio vignette of embarrassing scenarios to produce the experience of episodic self-referential events. Results showed transfer of episodic self-referential memory using the aIAT across identities that reported no conscious awareness of encoded content in DID. These aIAT results in DID patients were similar to the nonamnesic comparison group and the simulator group, and differed from the amnestic comparison group. These results are in line with previous literature showing transfer of memories, but extends this work to episodic self-referential memory. (PsycINFO Database Record (c) 2018 APA, all rights reserved).

[What is "normal"? Maternal parenting behavior as risk and protective factor for psychopathology and identity diffusion]. / Was ist noch "normal"? Mütterliches Erziehungsverhalten als Puffer und Risikofaktor für das Auftreten von psychischen Störungen und Identitätsdiffusion.

What is "normal"? Maternal parenting behavior as risk and protective factor for psychopathology and identity diffusion Objectives: This study analyzes the implications of today's highly altered maternal parenting behaviors on children's development and psychological health. METHODS: The relationship between maternal parenting behaviors (support, psychological control, and anxious monitoring) and delayed identity development or identity diffusion as well as internalizing or externalizing symptomatology was investigated in a sample of 732 youths (301 adolescents, 351 young adults, and 80 patients). Cluster analysis identified two types of maternal parenting behaviors: authoritative maternal behavior and dysfunctionalmaternal behavior. RESULTS: As expected, patients exhibited a high degree of dysfunctional maternal parenting behavior (low support, high psychological control), delayed identity development as well as elevated identity diffusion and symptomatology.Authoritative maternal parenting emerged as a protective factor in the prediction of identity diffusion and symptomatology.All three groups described a high degree of anxious maternal monitoring. CONCLUSIONS: The implications of changed maternal parenting behaviors on identity diffusion and symptomatology are discussed in light of societal changes and changing criteria of personality disorders in the new DSM-5.

Ways of understanding of religious delusions associated with a change of identity on the example of identification with Jesus Christ. / Sposoby rozumienia urojen religijnych zwiazanych ze zmiana tozsamosci na przykladzie identyfikacji z Jezusem Chrystusem.

Identification with Christ among psychiatric patients is an example of a complex and multifaceted phenomenon. As a delusion it includes a misidentification (change of identity) in the layer of content and, usually, grandiosity and/or paranoid traits in the formal aspect. What is more, it fits in the category of religious delusions, which are perhaps the most controversial type of delusions and as such require special sensitivity as well as knowledge beyond psychology or psychiatry. The aim of the articleis to show the phenomenon of identification with Christ among psychiatric patients, taking into account different ways of its explaining and understanding. Papers relating to the topic, both theoretical considerations and case studies, found in the EBSCO database were analyzed. Searching for the articles the following key words were used: identity, identification, delusion, Jesus/Christ/Messiah, psychosis, schizophrenia. The analysis included all (actually not numerous) articles except for the one linked to cognitive approach which did not significantly contribute to the issue. Given the multiplicity of ways of explaining and understanding the experience of identification with the figure of the Messiah, it seems to be a mistake to hold both objectivist and one-sided, based on one theory, attitude towards it. Such an experience should be recognized in the context of the history of patient's life and the all possible mechanisms leading to its occurrence, as well as the meanings hidden beneath the symptom, should be take into account. It is also important to be well-oriented in the system of religious beliefs and spiritual needs of the patient.

"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

[Ego-state Therapy: Psychotherapy for Multiple Personality Disorders].

The author describes ego-state therapy. This psychotherapy is used for treating multiple personality disorders. The author mentions the theoretical background of this method, and practical points. Initially, ego-state therapy was developed as a type of hypnotherapy, but it evolved as a safe therapeutic method in combination with trauma processing therapies. The author presents a case study, and discusses the clinical significance of this treatment.