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Questions and Answers
What is a significant critique of the trauma model in relation to Dissociative Identity Disorder (DID)?
Which model emphasizes the role of suggestibility in the development of dissociative symptoms?
What has been suggested as a contributing factor to the dramatic increase in DID diagnoses since the 1970s?
What aspect of trauma may serve as a significant variable influencing the expression of dissociative symptoms?
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Which of the following statements accurately reflects findings regarding the assessment of DID?
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What concept explains that alters in dissociative identity disorder reflect dissociated aspects of personality?
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Which factor is considered a vulnerability in developing dissociative symptoms according to socio-cultural influences?
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What has been proposed as a treatment approach for reducing dissociative symptoms?
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What is the primary characteristic of dissociative disorders in DSM-5?
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What are the common episodes experienced in Depersonalization/Derealization Disorder?
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Which type of dissociative amnesia is characterized by an inability to recall specific traumatic events?
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What is associated with the onset of Dissociative Identity Disorder (DID)?
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Which of the following is NOT considered a typical symptom of dissociative disorders?
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What distinguishes dissociative fugue from dissociative amnesia?
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Which psychological factor is believed to contribute to the mechanisms behind dissociation?
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What is a notable research limitation concerning dissociative disorders?
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What is a common misconception about the prevalence of Dissociative Identity Disorder?
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Study Notes
Dissociative Disorders
- Dissociative disorders involve disruption of consciousness, memory, identity, or perception of the environment.
- Dissociation is often triggered by exposure to extreme stress or trauma.
- Dissociation can be considered a coping mechanism for trauma.
Dissociation: Issues
- There is debate on the uniqueness of clinical phenomena and what constitutes a "normal" state of consciousness versus an "altered" state.
- Depersonalization disorder is a common dissociative experience.
- Dissociation is linked to suggestibility, fantasy proneness, and false memories.
- Sleep loss is associated with dissociation.
- Research on dissociation is limited due to small sample sizes, dimensional approach, and flawed treatment studies.
Dissociative Disorders in DSM-5
- Dissociative disorders in DSM-5 include:
- Depersonalization Disorder
- Dissociative Amnesia
- Dissociative Fugue
- Dissociative Identity Disorder (DID)
Depersonalization/Derealization Disorder
- Depersonalization involves feeling detached from one's mental processes or body.
- Derealization involves feeling detached from one's surroundings.
- About 50% of individuals experience mild, transient episodes of depersonalization/derealization.
- Severe, chronic depersonalization disorder affects 0.8-2.8% of the population.
- Often follows a stressful life event.
- Individuals may selectively inhibit emotions, possibly due to inhibitory control of emotional brain structures.
Dissociative Amnesia
- Dissociative amnesia involves the inability to recall important personal information, often traumatic in nature.
- Generalized amnesia is less common than localized or selective amnesia, which involves forgetting specific events.
- Dissociative fugue involves amnesia plus travel.
- Trance and possession are common in some cultures but are not considered pathological if consistent with those cultural practices.
Dissociative Identity Disorder (DID)
- DID involves disruption of identity (sense of self) and recurrent dissociative amnesias.
- Individuals with DID may "come to" in unfamiliar places and find unfamiliar objects.
- DID is often attributed to complex trauma, such as combat, cult abuse, and childhood trauma/abuse.
- DID is less common among older individuals.
- Trauma may lead to an unintegrated mind in vulnerable individuals.
DID: Clinical Picture
- Prevalence of DID is unknown due to a lack of accurate figures.
- Twin studies suggest a heritability factor of 50%, but data is inconsistent.
- Onset is typically in adolescence or early adulthood.
- 90% of individuals with DID report childhood trauma.
- Research on trauma is often flawed.
- Presenting complaints often include depression and headaches.
- DID is chronic in the absence of treatment.
DID: Rule Out
- DID must be differentiated from schizophrenia and other psychotic disorders.
- There is an unclear relationship with borderline personality disorder (BPD); some researchers view DID as extreme BPD or PTSD.
- Malingering (faking symptoms for personal gain) and factitious disorder (faking symptoms for attention) must be ruled out.
- Social-cultural influences can create symptoms that resemble DID.
Models of DID
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Biological models:
- Epilepsy-like condition - only a minority of individuals with DID have epilepsy.
- Blocking of memory circuits - there is limited evidence to support this.
- Emotional over-modulation - there is limited and inconsistent evidence to support this.
-
Trauma model:
- DID is viewed as a coping response to childhood trauma.
- Alters (different identities) may reflect aspects of personality being dissociated.
- Most common trauma is sexual abuse.
Critiques of the Trauma Model
- Dissociation is associated with other conditions, such as panic disorder and PTSD.
- Trauma history is often difficult to corroborate.
- Family maladjustment may be a better predictor than trauma history.
- Selection and referral biases may influence research findings.
- There was a dramatic increase in DID diagnoses from the 1970s to the 2000s, particularly in the USA.
- Leading questions during assessment and treatment may increase the likelihood of a DID diagnosis.
- Many individuals with DID show few signs of the condition before psychotherapy.
- Sleep disturbance and sleep-loss conditions are associated with DID.
- Sleep hygiene treatment can reduce dissociative symptoms.
Socio-Cognitive Model
- This model suggests that DID is a role enactment in suggestible individuals experiencing intense emotional symptoms.
- It is not considered malingering but rather a construct influenced by suggestion.
- "Recovered memory" phenomena (memories previously "forgotten" that are unexpectedly retrieved) play a role in this model.
Social-Cultural Influences
- Social-cultural influences can trigger dissociation.
- Suggestive influences, such as leading questions and repeated questioning, can contribute to DID.
- Media and socio-cultural influences can shape how individuals understand their experiences.
Conclusions
- DID remains a complex and controversial diagnosis.
- A lack of research and clear definitions of dissociation contribute to skepticism among many professionals.
- However, some professionals champion the diagnosis of DID.
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