Week 6 DID

Question 1

What is the DSM definition of DID?

Answer 1

1. 2 or more personality states

2. Amnesia

Question 2

Do alters have different physiological responses towards certain things?

Answer 2

Yes.

Actual differences found in allergies, handwriting, voice pattern, visual acuity etc

Question 3

What does the trauma model posit about DID?

Answer 3

Early trauma plays a key role in the genesis of dissociation

Question 4

What does the fantasy model posit about DID?

Answer 4

Fantasy proneness, suggestibility, cognitive failures and other variables foster dissociation.

Question 5

According to the trauma model, how does trauma result in DID?

Answer 5

Early trauma shatters the unified self, which becomes compartmentalized. Compartmentalization of personality into alters help individual to cope with the pain of early trauma. Can disconnect from reality (e.g little girl personality).

Indeed, the relationship between traumatic experiences and dissociation is causal according to the TM. dissociation will increase after known trauma, but over time the symptoms will wane spontaneously.

Alters are discovered

Question 6

According to the fantasy model or social cognitive model, how is DID formed?

Answer 6

DID as a social construct, caused by therapist curing and media influences. DID might be an acquired disorder. Alters are formed.

Question 7

Is it possible for alters to be not aware of each other?

Answer 7

Yes. Amnesia lor.

Opposite is possible also

Question 8

How do we best understand DID?

Answer 8

Having less than one personality, not having MULTIPLE personality. Like fractions of personalities.

Personality is fragmented and not unified, having these fractions funny around.

DID exists when these fractions cannot be reconciled to form a whole.

Question 9

Can alters have separate memory banks?

Answer 9

Yes. Unconscious memory & cognitive activation theory.

Unconscious memory: CAT: Cognitive Activation Theory.
EEG: Measures brain potential: particular profile (P3 potential) which lights up when you see something familiar. Altar A is shown an object. But when altar B is shown, P3 is activated – supports that there is a shared memory bank? Neural activation does not equate to experience? Did not exclude the possibility that they were lying?

Question 10

Evaluate the efficacy of the trauma model in targeting DID.

Answer 10

(+) symptoms reduction

(-) results found were based on correlational and cross-sectional studies

Question 11

Evaluate the efficacy of the socio-cognitive model in targeting DID.

Answer 11

1. No objective measure of whether trauma was experienced.
2. Symptom reduction not found, but rather very low to begin with already.
3. If you say DID is a social construct, then could it be other illnesses instead? Schizo? Depression? BPD? A lot of DID patients also have BPD.
4. Might have PTSD or complex trauma also because client almost always have extensive history of trauma.
5. Might BPD be a simpler diagnosis to give than DID? DID is a difficult diagnosis to give. BPD is those who lie in the middle of fragmented personality and fully formed personality. Neither here or there, quite jialat also.

Question 12

List 5 things that are commonly done during treatment. 1

Answer 12

1. Asking to meet alters - some clients can consciously get into their alters, sometimes the switch even occurs without their knowledge.
2. Name the alters to make identification easier.
3. Letting alters speak to each other. Provide a board where client will leave post-it notes for the different alters (especially if they have no conscious memory of their alters). This is to allow their alters to reconcile to form a unified whole. As a therapist, you are the director of this board of post-its.
4. Give each alter airtime.
5. Change of living environment as certain alters might be activated by stressors/triggers in the environment.

Question 13

Strive towards ______ to manage symptoms.

Answer 13

Integration.

Question 14

Another way to manage symptoms is through functional analysis. What does this encompass?

Answer 14

Understanding that each behaviour represents a certain function. Same thing for alters

• Child alter represents desire to get atttention.
• Wise alter represents desire to give advice.
• Crocodile alter could represent animalistic advice with unbridled desires.

Ask client to reflect the purpose of each alter and ask if there is an alternative way to strike a balance.

Question 15

Hypnotherapy is a therapy in support of ______ mode.

Answer 15

Trauma model because it digs into the past.

Question 16

When the number of alters increases over the course of treatment, this lends support to which model?

Answer 16

Fantasy mode/ SCM.

Question 17

Give two examples on how culture plays a role in the treatment of DID.

Answer 17

1. India
   - Transition between alters preceded by sleep.
   - Similar to what was being portrayed in the media (supports SCM).
   - However, in Western countries, the switch is instantaneous.
2. Japan
   - Only 5 cases in 1990, but after 1990, more than 30 cases.
   - Shows support for the SCM model as people could have been influenced by the media.

Question 18

How does the extent of being aware of DID aetiology influence DID treatment?

Answer 18

You know what to do roughly, but executing it takes a long time.

How much can you do to switch alters? Varies for person and varies for alters. Some alters can bring on more easily.

Clients only have awareness for some alters, not all. Even so, they might not know the genesis for all alters.

Question 19

Evaluate the effectiveness of DBT on DID.

Answer 19

Pros:
Suitable because certain components like DT and ER skills can reduce impulsive behaviours in DID.
Mindfulness can help decrease dissociation and improve grounding skills.

Cons:
DBT treats an individual as a whole, so this approach won’t recognize the alters DID clients have. Lack of acknowledgement can be invalidating
Does not treat trauma directly.

Question 20

Can different alters have different mental disorders?

Answer 20

yes.

Question 21

According to Allen & Movius, did ERP show that participants have amnesia?

Answer 21

No, they did not. Were aware of different alters actually.

Question 22

how is FM not compatible with DID?

Answer 22

Does not consider that a variety of stressors, including not only highly aversive events but also isolation and loneliness, can foster propensity to fantasize, disrupt sleep and increase vulnerability to suggestive influence

Question 23

Describe how objective trauma may enable the emergence of dissociative symptoms in the short-term.

Answer 23

1) Increase stress level
2) Accurate perception of circumstances being unreal after unexpected/horrifying events
3) Post traumatic dissociative reactions that are the product of imagination
4) Disrupted sleep –> predisposed to certain dissociative experiences

Question 24

What does the author of Dalenberg critique paper acknowledge about FM?

Answer 24

1) Bio vulnerabilities to trauma genesis, as well as moderators and mediators in it
2) Difficult to completely parcel out how potential effects of trauma are caused by pathogenic family environment
3) DID is in part a disorder of self-understanding and those with DID have inaccurate idea that they are more than one person. (moved closer to FM)
4) Trauma may sometimes play a role in dissociation, but author view this role as less central, specific and causally necessary.
5) Fantasy proneness can lead to inaccurate trauma reports.

Question 25

TM predicts a consistent positive relationship across studies between trauma and dissociation, whereas proponents of FM argue that dissociation is a psychological process causally unrelated to antecedent traumatic or stressful events
True or false?

Answer 25

False.

Modest relationship at best between dissociation and trauma.

Question 26

Studies have found a relation between trauma and dissociation when using objective measures of trauma.

Yes or no?

Answer 26

NO. usually got seriously methodological flaws like diagnostic bias

Question 27

Trauma would account for variance in dissociation beyond that predicted by fantasy proneness by not vice versa.

True or false

Answer 27

False. Other factors also important. Like parental abuse, dysfunction etc.

Fantasy proneness still accounted for significant variance in dissociation.
SEM to compare TM and FM – SEM did not support either model umambiguously but it affirmed the importance of fantasy proneness. But analysis does not permit a determination of whether the relation between dissociation and trauma, which is partially mediated by fantasy proneness, indicates that fantasy fuels trauma self-reports, fantasy functions as a defence or coping mechanisms following trauma exposure or both.

Question 28

Contrary to the FM, the relation between dissociation and false memory should be weak and consistent.

True or false?

Answer 28

True

If you use TM to predict then true, because lab studies examining the relation between dissociation and false memory only get modest results.

But studies using DES-C was excluded for some reason. Should be more comprehensive to see if this is really true.

Question 29

TM predicts that dissociation should be related to decreased narrative cohesion and increased memory fragmentation

True or false?

Answer 29

False, FOR NOW.
• Strong self-reported association between dissociation and memory fragmentation is not confirmed by objective measures of fragmentation
• Trait dissociation was inconsistently associated with self-reports of memory fragmentation

Can have other 3rd variables explaining this also.

FM does not exclude the possibility that highly aversive events can produce memory fragmentation. Stressors might interfere with encoding and anxiety, cognitive factors and intrusion and fantasy-related material during recall might compromise narrative cohesion.

Question 30

List 4 benefits that participants who underwent outpatient, community DID treatment experienced.

[the patient-rated ones]

Answer 30

Patient reports of dissociative symptoms, general psychiatric symptoms, depression and PTSD symptoms decreased significantly over the course of the study. Except the DES, the decreases attenuated over time as indicated by significant positive quadratic effects

Patient report of any pain decreased significantly over time.

Patients reported significant decreases over time in 30-day rates of self-harm, doing something dangerous, and doing something very impulsive.

Patient report of suicide attempts past 30 days did not significantly decrease.

Use of prescription and street drugs to become intoxicated in the past 30 days decreased by 44% in the odds of use by month

More frequent involvement in volunteer jobs, attending school, socializing with friends and feeling good as treatment progressed

Question 31

What are some limits to DID treatment?

Answer 31

1. Complete symptom relief is too far-fetched a goal to work towards. Because comorbid with so many things!
2. IF not careful, they might regress. Therapy is not always linear.