Chapter 7 (pg 198 - 209) Flashcards
Dissociative Disorders
Have you ever felt detached from yourself or your surroundings?
- During these experiences some people feel as if they are dreaming.
- These mild sensations that most people experience periodically are slight alterations, or detachments, in consciousness or identity called dissociative experiences, but they are perfectly normal.
For a few people, these experiences are so intense and extreme that they lose their identity entirely and assume a new one, or they lose their memory or sense of reality and are unable to function.
Morton Prince, founder of the prestigious Journal of Abnormal Psychology, noted more than a century ago that many people experience something like dissociation occasionally
- It is most likely to happen after an extremely stressful or traumatic event, such as an accident.
- It might also happen when you’re very tired or under physical or mental pressure from, say, staying up all night cramming for an exam
- If you have had an experience of dissociation, it may not have bothered you much, perhaps because you knew the cause. On the other hand, it may have been extremely frightening.
These kinds of experiences can be divided into two types.
- During an episode of depersonalization, your perception alters so that you temporarily lose the sense of your own reality.
- During an episode of derealization, your sense of the reality of the external world is lost. Things may seem to change shape or size; people may seem dead or mechanical.
Symptoms of unreality are characteristic of the dissociative disorders because depersonalization is, in a sense, a psychological mechanism whereby one dissociates from reality.
- Depersonalization is often part of a serious set of conditions where reality, experience, and even our own identity seem to disintegrate.
What happens if we can’t remember why we are in a certain place or even who we are? What happens if we lose our sense that our surroundings are real? Or what happens if we not only forget who we are but also begin to think we are somebody else—somebody who has a different personality, different memories, and even different physical reactions, such as allergies, that we never had?
- These are examples of disintegrated experience.
- In each case, there are alterations in our relationship to the self, to the world, or to our memory processes.
Subtopics:
- Depersonalization-Derealization Disorder
- Dissociative amnesia
- Dissociative identity Disorder
a. Clinical description
b. Characteristics
c. Can DID Be Faked?
d. Statistics
e. Causes
i. Suggestibility
ii. Biological contributions
iii. Real and False Memories
f. Treatment
Depersonalization-Derealization Disorder
When feelings of unreality are so severe and frightening that they dominate an individual’s life and prevent normal functioning, clinicians may diagnose the very rare depersonalization-derealization disorder.
The individual has repeated experiences of feeling detached from his or her own thoughts or body.
- The person may feel as if he or she is an outside observer of his or her own body or thoughts—for example, feeling as if he or she is dreaming.
- But unlike someone experiencing psychosis, the person experiencing episodes of depersonalization- derealization remains in good contact with reality—the person knows, for example, that he or she is not really an outside observer of his or her own body.
- Trying to describe the uncomfortable feeling of depersonalization-derealization can be very difficult to convey in words.
Feelings of depersonalization-derealization are part of several different disorders
- But when severe depersonalization-derealization is the primary problem, the individual meets the criteria for depersonalization-derealization disorder
Diagnostic Criteria for Depersonalization-Derealization Disorder:
A. The presence of persistent or recurrent experiences of deperson- alization, derealization, or both:
1. Depersonalization: Experiences of unreality, detachment, or
being an outside observer with respect to one’s thoughts, feelings, sensations, body or actions (e.g., perceptual altera- tions, distorted sense of time, unreal or absent self, emotional and/or physical numbing).
2. Derealization: Experiences of unreality or detachment with respect to surroundings (e.g., individuals or objects are experienced as unreal, dreamlike, foggy, lifeless, or visually distorted).
B. During the depersonalization or derealization experience, reality testing remains intact.
C. The symptoms cause clinically significant distress or impairment in social, occupational, or other important areas of functioning.
D. The disturbance is not attributable to the physiological effects of a substance (e.g., a drug of abuse, medication) or another med- ical condition (e.g., seizures).
E. The disturbance is not better explained by another mental dis- order, such as schizophrenia, panic disorder, major depressive disorder, acute stress disorder, post-traumatic stress disorder, or another dissociative disorder.
Montreal researchers Jean Charbonneau and Kieron O’Connor interviewed 20 individuals who were self-referred from the general population as experiencing depersonalization-derealization.
- They found that in the majority of cases, onset occurred following a traumatic life event, after sexual abuse, or after giving birth.
Mean age of onset was 16.1 years old and the course tended to be chronic, lasting an average of 15.7 years so far in those cases.
- All the patients were substantially impaired.
- Although none had any additional dissociative disorders, more than 50% had additional mood and anxiety disorders.
Guralnick, Schmeidler, and Simeon compared 15 patients with depersonalization-derealization disorder to 15 matched comparison subjects without the disorder on a comprehensive neuropsychological test battery that assessed cognitive function.
- Although both groups were of equal intelligence, the subjects with depersonalization-derealization disorder showed a distinct cognitive profile, reflecting some specific cognitive deficits on measures of attention, short-term memory, and spatial reasoning.
- Basically, depersonalization-derealization disorder patients were easily distracted and had some trouble perceiving three-dimensional objects because they tended to flatten these objects into two dimensions.
- It is not clear how these cognitive and perceptual deficits develop, but they seem to correspond with reports of tunnel vision (perceptual distortions) and mind emptiness (difficulty absorbing new information) that characterize these patients.
Specific aspects of brain functioning are also associated with depersonalization-derealization
- Sierra compared skin conductance responding, a psychophysiological measure of emotional responding, among 15 patients with depersonalization-derealization disorder, 11 patients with anxiety disorders, and 15 participants without any disorder.
- Patients with depersonalization-derealization disorder showed greatly reduced emotional responding compared with other groups, reflecting a tendency to selectively inhibit emotional expression.
- Brain-imaging studies now confirm deficits in perception and emotion regulation
- Other studies note dysregulation in the hypothalamic–pituitary–adrenocortical (HPA) axis among these patients, compared with normal controls, suggesting deficits in emotional responding.
Psychological treatments have not been systematically studied.
- One evaluation of the drug Prozac did not show any treatment effect compared with placebo
Dissociative amnesia
People who are unable to remember anything, including who they are, are said to have generalized amnesia.
- Generalized amnesia may be lifelong or may extend from a period in the more recent past, such as six months or a year previously.
Far more common than general amnesia is localized amnesia or selective amnesia, a failure to recall specific events, usually traumatic, that occur during a specific period
- In fact, dissociative amnesia is very common during war
A possible case of dissociative amnesia in Canada was the first-degree murder trial of Kenneth Mackay in Saskatoon
- Mackay was charged with killing Crystal Paskemin in 2000.
- Although Mackay admitted to having run over the victim with his truck, which he claimed was an accident, he could not explain why the victim’s body was found burned.
- His defence lawyer claimed that Mackay had forgotten about burning the victim’s body because of the trauma of the accident.
- In fact, a memory expert testified in court that Mackay may have had dissociative amnesia.
- Despite the expert witness testimony, the jury rejected his defence, and Mackay was sentenced to life in prison with no possibility of parole for 25 years
A subtype of dissociative amnesia is referred to as dissociative fugue
- fugue literally means “flight”
- memory loss revolves around a specific incident—an unexpected trip (or trips).
- Mostly, individuals simply leave and later find themselves in a new place, unable to remember why or how they got there. Usually, they have left behind an intolerable situation.
During these trips a person
sometimes assumes a new identity or at least becomes confused about the old identity.
Dissociative amnesia seldom appears before adolescence and usually occurs in adulthood.
- It is rare for dissociative amnesia to appear for the first time after an individual reaches the age of 50
- Once dissociative disorders do appear, however, they may continue well into old age.
- Estimates of prevalence range anywhere from 1.8% to 7.3%, suggesting that dissociative amnesia is the most prevalent of all the dissociative disorders
Fugue states usually end rather abruptly
- In this disorder, the disintegrated experience is more than memory loss, involving at least some disintegration of identity, if not the complete adoption of a new one.
An apparently distinct dissociative state not found in Western cultures is called amok (as in “running amok”).
- Most people with this disorder are males.
- Amok has attracted attention because individuals in this trance-like state often brutally assault and sometimes kill people or animals.
- If the person is not killed himself, he probably will not remember the episode.
- Running amok is only one of several “running” syndromes in which an individual enters a trance-like state and suddenly, imbued with a mysterious source of energy, runs or flees for a long time.
- Except for amok, the prevalence of running disorders is somewhat greater in women, as with most dissociative disorders. Among the Inuit, running disorder is termed pivloktoq.
- Among the Navajo tribe, it is called frenzy witchcraft.
- Despite their different culturally determined expression, running disorders seem to resemble dissociative fugue, with the possible exception of amok.
Trance and possession are a common part of some traditional religious and cultural practices and are not considered abnormal in that context.
- Dissociative trances commonly occur in India, Nigeria (where they are called vinvusa), Thailand (phiipob), and other Asian and African countries
- In North America, culturally accepted dissociation commonly occurs during African-American prayer meetings, First Nations sweat lodge ceremonies, and Puerto Rican spiritist sessions
- Among Bahamians and blacks from the southern United States, trance syndromes are often referred to colloquially as “falling out.”
- Only when the state is undesirable and considered pathological by members of the culture would the individual be diagnosed with dissociative trance disorder (DTD) as a subtype of dissociative identity disorder
Clinical description - Dissociative identity Disorder
People with dissociative identity disorder (DID) may adopt as many as 100 new identities, all simultaneously co-existing inside one body and mind.
- In some cases, the identities are complete, each with its own behaviour, tone of voice, and physical gestures.
- In other cases, only a few characteristics are distinct, because the identities are only partially independent, so it is not true that there are “multiple” complete personalities.
DSM-5 criteria for dissociative identity disorder include amnesia, as in dissociative amnesia. In DID, however, identity is also fragmented.
- How many identities are displayed is relatively unimportant, whether there are three, four, or even 100 of them.
- Rather, the defining feature of this disorder is that certain aspects of the person’s identity are dissociated
Characteristics - Dissociative identity Disorder
The identity who becomes the patient and asks for treatment is usually a host identity.
- The first identity to seek treatment is rarely the original identity of the person.
- Usually, the host personality develops later
- Many patients have at least one impulsive alter who handles sexuality and generates income, sometimes by acting as a prostitute.
- In other cases, all alters may abstain from sex.
- Cross-gendered alters are not uncommon
The transition from one personality to another is called a switch
- Usually, the switch is instantaneous (although in movies and television it is often drawn out for dramatic effect).
- Physical transformations may occur during switches. Posture, facial expressions, patterns of facial wrinkling, and even physical disabilities may emerge.
- In one study, changes in handedness occurred in 37% of the cases
Can DID Be Faked? - Dissociative identity Disorder
The question of faking is relevant for all dissociative disorders but tends to be raised more often for dissociative identity disorder.
It is very difficult to answer this question for several reasons
- First, evidence indicates that individuals with DID are very suggestible. It is possible that alters are created in response to leading questions from therapists, either during psychotherapy or while the person is in a hypnotic state.
Some investigators have studied the ability of individuals to fake dissociative experiences.
- Nicholas Spanos conducted important work on this issue. Spanos, Weeks, and Bertrand demonstrated that a university student could simulate an alter if it was suggested that faking was plausible.
- These findings on faking and the effect of hypnosis led Spanos to suggest that the symptoms of DID could be accounted for by therapists who inadvertently suggested the existence of alters to suggestible individuals, a model known as the sociocognitive model because the possibility of identity fragments and early trauma is socially reinforced by a therapist
- A survey of American psychiatrists showed little consensus on the scientific validity of DID, with only one-third in the sample believing the diagnosis should be included without reservation in the DSM
- A similar study of Canadian psychiatrists showed that fewer than one-third had no reservations about including DID in the DSM
- Canadian psychiatrists were significantly more skeptical about the legitimacy of the DID diagnosis than were the American psychiatrists.
The diagnosis of captured the fascination of the public after popular books, movies, and TV series appeared on this topic.
- Chris Costner Sizemore was the real-life subject of a popular book and movie The Three Faces of Eve.
- Sizemore, who used the pseudonym Evelyn Lancaster in her book, was played by Joanne Woodward, who later received the Academy Award for Best Actress for her role in the movie.
- Woodward later also played the psychiatrist who treated another patient with DID in the 1976 TV miniseries Sybil. The patient in Sybil was played by Sally Fields who won an Emmy Award for her role in the film.
Objective tests suggest, however, that many people with fragmented identities are not consciously and voluntarily simulating
- a study by Eric Eich compared the performance of real DID patients and simulators on objective memory tests. They found that “interpersonality amnesia” (i.e., in which events experienced by a particular personality state or identity are retrievable by the same identity but not by a different one; could not be explained by deliberate simulating.
- In another study, Condon, Ogston, and Pacoe examined Sizemore and determined that one of the personalities (Eve Black) showed a transient micro-strabismus (divergence in conjugant lateral eye movements) that was not observed in the other personalities. These optical differences have been confirmed by Miller, who demonstrated that DID subjects had 4.5 times the average number of changes in optical functioning in their alter identities that control subjects had who simulated alter personalities. Miller concludes that optical changes, including measures of visual acuity, manifest refraction, and eye muscle balance, would be difficult to fake.
- Ludwig found that Jonah’s various identities had different physiological responses—including galvanic skin response (GSR), a measure of otherwise imperceptible sweat gland activity, and electroencephalogram (EEG) brain waves—to emotionally laden words.
- Using up-to-date functional magnetic resonance imaging (fMRI) procedures, changes in brain function were observed in one patient while switching from one personality to another. Specifically, this patient showed changes in hippocampal and medial temporal activity after the switch
- A number of subsequent studies confirmed that various alters have unique psychophysiological profiles
- Patients with DID, conversely, are more likely to attempt to hide symptoms.
The notion of multiple identities living inside someone’s body and competing with each other for access to the outside world is based on the old idea that there is a self that lives inside each of us (and on the modern notion that that self can be fragmented).
- This idea is often portrayed in popular movies like The Change-Up, in which two friends trade bodies but maintain their personalities.
- There is indeed a self, but that self is not dissociable from the body.
- There is no doubt that some people feel as if there are multiple persons or personalities living inside them, but that feeling need not be taken literally.
The neurological and physiological differences observed for different alters may simply reveal the fact that the different identities are often associated with very specific emotional states (e.g., calm and collected versus impulsive and angry)
Statistics - Dissociative identity Disorder
The average number of alter personalities is reported by clinicians as closer to 15
Of people with DID, the ratio of females to males is as high as nine to one
- The onset is almost always in childhood, often as young as 4 years of age, although it is usually approximately 7 years after the appearance of symptoms before the disorder is identified
Once established, the disorder tends to last a lifetime in the absence of treatment.
- The form it takes does not seem to vary substantially over the person’s lifespan, although some evidence indicates that the frequency of switching decreases with age
- Different personalities may emerge in response to new life situations
Some have argued that, in the past, dissociative disorders may have been overlooked or misdiagnosed by mental health professionals
Semistructured interviews of large numbers of inpatients with severe disturbances found prevalence rates of DID of between 3% and 6% in Canada and the United States, and approximately 2% in Holland
A very large percentage of DID patients have simultaneous psychological disorders that may include substance abuse, depression, somatization disorder, borderline personality disorder, panic attacks, and eating disorders
- a study of 42 patients documented a pattern of severe comorbid personality disorders, including severe borderline pathology
- It seems likely that different personalities will present with differing patterns of comorbidity
- In some cases this high rate of comorbidity may reflect the fact that certain disorders, such as borderline personality disorder, share many features with DID—for example, self-destructive, sometimes suicidal behaviour, and emotional instability.
- Some investigators believe that most of DID symptoms can be best accounted for by characteristics of borderline personality disorder
The high frequency of additional disorders accompanying DID reflects an intensely severe reaction to what seems to be in almost all cases horrible child abuse.
- Because auditory hallucinations are very common, DID is often misdiagnosed as a psychotic disorder.
- But the voices in DID are reported by patients as coming from inside their heads, not outside as in psychotic disorders.
- Because patients with DID are usually aware the voices are hallucinations, they don’t report them and instead try to suppress them.
- These voices often encourage doing something against the person’s will, so some individuals, particularly in other cultures, appear to be possessed by demons
DID seems to occur in a variety of cultures throughout the world, particularly in terms of experiencing possession, which is one manifestation of DID
Causes - Dissociative identity Disorder
Life circumstances that encourage the development of DID seem quite clear
- Almost all patients presenting with this disorder report to their mental health professional that they were horribly, often unspeakably, abused as a child.
Most surveys report a very high rate of childhood trauma in cases of DID
- Putnam found that 97% of the patients had experienced significant trauma, usually sexual or physical abuse.
- 68% reported incest.
- A study by Colin Ross was conducted on identified cases of DID from Winnipeg, Utah, California, and Ottawa. They reported that 95% reported physical or sexual abuse, and the prevalence of abuse histories
- Some children reported being buried alive. Some were tortured with matches, steam irons, razor blades, or glass.
- Investigators have corroborated the existence of at least some early sexual abuse in 12 patients with DID, by examining early records, interviewing relatives and acquaintances, and so on
- Harold Merskey analyzed several studies claiming to corroborate abuse reports among DID patients. Merskey noted several methodological deficiencies in the research in this area, causing him to question whether we yet have corroborative evidence of childhood abuse in DID.
- Kluft cautions that some reports of childhood abuse by DID patients are not true and have been confabulated (made up).
In cases where childhood trauma does contribute to DID development, it is important to note that not all the trauma is caused by abuse.
- Putnam describes a young girl in a war zone who saw both her parents blown to bits in a minefield. In a heart-rending response, she tried to piece the bodies back together, bit by bit.
Such observations have led to wide-ranging agreement that DID is rooted in a natural tendency to escape or dissociate from the unremitting negative affect associated with severe childhood trauma
- A lack of social support during or after the trauma also seems to be implicated.
- Waller and Ross demonstrated that a surprisingly high percentage (33% to 50%) of the variance in dissociative experience could be attributed to a chaotic, nonsupportive family environment.
- The remainder of the variance was associated with individual experience and personality factors.
The behaviour and emotions that make up disorders seem to be related to otherwise normal tendencies present in all of us to some extent.
- It is quite common for otherwise normal individuals to escape in some way from emotional or physical pain
- Noyes and Kletti surveyed survivors of various life-threatening situations and found that most had experienced some type of dissociation, such as feelings of unreality, a blunting of emotional and physical pain, and even separation from their bodies.
- Dissociative amnesia and fugue states are clearly reactions to severe life stress. But the life stress or trauma is in the present rather than the past
- Many patients are escaping from legal difficulties or severe stress at home or on the job
But sophisticated statistical analyses indicate that ordinary dissociative reactions differ substantially from the pathological experiences we’ve described, and that at least some people do not develop severe pathological dissociative experiences no matter how extreme the stress.
- These findings are consistent with the diathesis-stress model, in that only with the appropriate vulnerabilities (the diathesis) will a person react to stress with pathological dissociation.
You may have noticed that DID seems very similar in its etiology to post-traumatic stress disorder (PTSD).
- Both conditions feature strong emotional reactions to experiencing a severe trauma
- But remember that not everyone goes on to experience PTSD after severe trauma. Only people who are biologically and psychologically vulnerable to anxiety are at risk for developing PTSD in response to moderate levels of trauma.
- As the severity of the trauma increases, however, a greater percentage of people develop PTSD as a consequence, some with the dissociative subtype of PTSD.
- But some people do not become victims of the disorder even after the most severe traumas, suggesting that individual psychological and biological factors interact with the trauma to produce PTSD.
There is a growing opinion that DID is an extreme subtype of PTSD, with a much greater emphasis on the process of dissociation than on symptoms of anxiety, although both are present in each disorder
- Some evidence also shows that the developmental window of vulnerability to the abuse that leads to DID closes at approximately 9 years of age
- After that, DID is unlikely to develop, although severe PTSD might.
If true, this is a particularly good example of the role of development in the etiology of psychopathology.
i. Suggestibility
ii. Biological contributions
iii. Real and False Memories
Suggestibility - Dissociative identity Disorder
Suggestibility is a personality trait distributed normally across the population, much like weight and height.
- Some people are much more suggestible than others; some are relatively immune to suggestibility; and the majority fall in the mid-range.
Did you ever have an imaginary childhood playmate? Many people did, and it is one sign of the ability to lead a rich fantasy life, which can be very helpful and adaptive.
- However, having had an imaginary childhood playmate is much more common among those with DID than among people in the general population.
- Having had an imaginary playmate in childhood also seems to correlate with being suggestible or easily hypnotized (some people equate the terms suggestibility and hypnotizability).
A hypnotic trance is also very similar to dissociation
- People in a trance tend to be totally focused on one aspect of their world, and they become very vulnerable to suggestions by the hypnotist.
- There is also the phenomenon of self-hypnosis, in which individuals can dissociate from most of the world around them and “suggest” to themselves that, for example, they won’t feel pain in one of their hands.
According to the autohypnotic model, people who are suggestible may be able to use dissociation as a defence against extreme trauma
- According to the work of Colin Ross, as many as 50% of DID patients clearly remember imaginary playmates in childhood
- When the trauma becomes unbearable, the person’s very identity
splits into multiple dissociated identities.
- Children’s ability to distinguish clearly between reality and fantasy as they grow older may be what closes the developmental window for
developing DID at approximately age 9.
- People who are less suggestible may develop a severe post-traumatic stress reaction but not a
dissociative reaction.
Biological contributions - Dissociative identity Disorder
There is a biological contribution to DID.
In a large twin study, none of the variance or identifiable causal factors were attributable to heredity: They were all environmental.
- In contrast, another twin study found evidence for a strong genetic contribution to dissociative disorder symptoms. About half the variance in dissociative symptoms was attributable to genetic factors
Individuals with certain neurological disorders, particularly seizure disorders, experience many dissociative symptoms
- Especially temporal lobe epileptic seizure can be associated with dissociative symptoms
- Patients with dissociative experiences who have seizure disorders are clearly different from those who do not
- The patients with seizures develop dissociative symptoms in adulthood that are not associated with trauma, in clear contrast to DID patients without seizure disorders.
Head injury and resulting brain damage may induce amnesia or other types of dissociative experience.
- But these conditions are usually easily diagnosed because they are generalized, irreversible, and associated with an identifiable head trauma
Lastly, strong evidence exists that sleep deprivation produces dissociative symptoms, such as marked hallucinatory activity
- the symptoms of individuals with DID seem to worsen when they feel tired.
- patients with DID “often liken it to bad jet lag and feel much worse when they travel across time zones”
Real and False Memories - Dissociative identity Disorder
Some clinical scientists suggest that many sexual abuse memories are the result of strong suggestions by careless therapists who assume people with this condition have been abused.
Whenever clinical decisions are based on a person’s memory, it is important to consider the fact that memories are not always very accurate or even true, even if they feel true.
- But this controversy often arises in the context of studying traumatic memories, particularly as identified in DID
If early sexual abuse did occur but was not remembered because of dissociative amnesia, it is important to re-experience aspects of the trauma under the direction of a skilled therapist to relieve current suffering.
- Without therapy the patient is likely to experience PTSD or a dissociative disorder indefinitely.
- It is also important that perpetrators are held accountable for their actions, perhaps through the legal system.
Connie Kristiansen has expressed concern that because the validity of recovered memories has been questioned, this may discourage those who have been abused from speaking out about their abuse, decreasing the chance that perpetrators of abuse will be punished for their crimes
- On the other hand, if memories of early trauma are inadvertently created in response to suggestions by a careless therapist but seem real to the patient, false accusations against loved ones could lead to irreversible family breakup and, perhaps, unjust prison sentences for those falsely accused as perpetrators.
In recent years, allegedly inaccurate accusations based on false memories have led to substantial lawsuits against therapists, resulting in awards of millions of dollars in damages.
There is irrefutable evidence that false memories can be created by reasonably well-understood psychological processes
Some authors content that early traumatic experiences can cause selective dissociative amnesia, with substantial implications for psychological functioning
- In contrast, others question the assumption that people can encode traumatic experiences without being able to recall them
In an official position statement on recovered memories, the Canadian Psychiatric Association warned that childhood memories later recovered in adulthood were of questionable reliability and should never be accepted without corroboration
- Similarly, in 1998, the Canadian Psychological Association recommended to the federal justice minister that a full judicial inquiry should be undertaken in all convictions in Canada that stemmed from evidence involving recovered memories. Although the federal government rejected this recommendation, it illustrates the attempts of professional bodies to ensure that recovered memory evidence cannot be used to convict people innocent of the crime in question
Evidence supporting the existence of distorted or illusory memories comes from lab-based experiments conducted by cognitive psychologists. - For example, Loftus, Coan, and Pickrell successfully convinced several individuals that they had been lost for an extended time when they were approximately 5 years old, which was not true.
Another study by Stephen Porter and John Yuille and Darrin Lehman tested whether it is possible to “remember” a highly emotional event that never actually occurred.
- These researchers first contacted participants’ parents to learn about which of a variety of stressful events (e.g., being seriously attacked by an animal) each participant had actually been exposed to as a child.
- Then, participants were brought into the laboratory and were encouraged by interviewers to “recover” a memory for a false event using guided imagery and repeated attempts to retrieve the memory.
- The false events were presented to the participants as actually having happened to them, according to their parents’ reports.
- A shockingly large number of participants “recovered” a full (26%) or partial (another 30%) memory for the false experience.
Williams interviewed 129 women with previously documented histories, such as hospital records, of having been sexually abused as children.
- 38% percent did not recall the incidents that had been reported to authorities at least 17 years earlier, even with extensive probing.
- Dissociative amnesia was more extensive if the victim had been very young and knew the abuser.
Elliot surveyed 364 individuals out of a larger group who had experienced substantial trauma, such as a natural disaster, car accident, or physical abuse.
- Fully 32% reported delayed recall of the event, which suggested at least temporary dissociative amnesia. This phenomenon was most prevalent among combat veterans, people who had witnessed the murder or suicide of a family member, and those who had suffered sexual abuse.
- The severity of the trauma predicted the extent of the amnesia, and the most common trigger for recalling the trauma was a media presentation, such as a movie.
How will this controversy be resolved? Because false memories can be created through strong repeated suggestions by an authority figure, therapists must be fully aware of the conditions under which this is likely to occur, particularly when dealing with young children.
- This situation requires an extensive knowledge of the workings of memory and other aspects of psychological functioning and illustrates, once again, the dangers of dealing with inexperienced or inadequately trained psychotherapists.
- Elaborate tales of satanic abuse of children under the care of women in daycare centres are most likely cases of memories implanted by aggressive and careless therapists or law enforcement officials
Advocates on both sides of this issue agree that clinical science must proceed as quickly as possible to specify the processes under which the implantation of false memories is likely and to define the presenting features that indicate a real but dissociated traumatic experience
- Until then, mental health professionals must be extremely careful not to prolong unnecessary suffering, among both victims of actual abuse and people falsely accused as abusers
Treatment - Dissociative identity Disorder
Individuals who experience dissociative amnesia or a fugue state usually get better on their own and remember what they have forgotten.
- The episodes are so clearly related to current life stress that prevention of future episodes usually involves therapeutic resolution of the distressing situations and increasing the strength of personal coping mechanisms.
- When necessary, therapy focuses on recalling what happened during the amnesic or fugue states, often with the help of friends or family who know what happened, so patients can confront the information and integrate it into their conscious experience.
For DID, however, the process is not so easy.
- With the person’s very identity shattered into many different elements, reintegrating the personality might seem hopeless.
- many documented successes exist of attempts to reintegrate identities through long-term psychotherapy
Coon found that only 5 out of 20 patients achieved a full integration of their identities.
- Ellason and Ross reported that 12 out of 54 (22%) patients in Canada and the United States had achieved integration 2 years after presenting for treatment, which in most cases had been continual.
The strategies that therapists use today in treating DID are based on accumulated clinical wisdom, as well as on procedures that have been successful for PTSD
- The fundamental goal is to identify cues or triggers that provoke memories of trauma or dissociation and to neutralize them.
More importantly, the patient must confront and relive the early trauma and gain control over the horrible events, at least as they recur in the patient’s mind
- To instill this sense of control, the therapist must skilfully, and very slowly, help the patient visualize and relive aspects of the trauma until it is simply a terrible memory instead of a current event.
- Because the memory is unconscious, aspects of the experience are often not known to either the patient or the therapist until they emerge during treatment.
Hypnosis is often used to access unconscious memories and bring various alters into awareness.
- Because the process of dissociation may be very similar to the process of hypnosis, the latter may be a particularly efficient way to access traumatic memories
We know that DID seems to run a chronic course and very rarely improves spontaneously, which suggests that current treatments, primitive as they are, have some effectiveness.
It is possible that re-emerging memories of trauma may trigger further dissociation.
- The therapist must be on guard against this happening.
- Trust is important to any therapeutic relationship, but it is absolutely essential in the treatment of DID.
Occasionally, medication is combined with therapy, but there is little indication that it helps much.
- What little clinical evidence there is indicates that antidepressant drugs might be appropriate in some cases
