Dissociative identity disorder and ambivalence

While many theorists have argued that dissociative identity disorder (DID) is a case of multiple selves or persons in a single body, I maintain that DID instead should be understood as involving a single self who suffers from significant disruptions to self-consciousness. Evidence of overlapping abilities and memories, as well as the very logic of dissociation, supports the claim that DID results from internal conflict endured by a single self. Along these lines, I will maintain that alter-formation should be understood as the result of extreme emotional ambivalence. While it is true that subjects with DID exhibit volitional conflict, as Frankfurt [1988. The Importance of What We Care About. New York: Cambridge University Press; 1999. Necessity, Volition, and Love. New York: Cambridge University Press] maintains, I argue that these incompatible volitions have a deeper source: conflicting desires and affective stances concerning basic emotional needs that are not easily abandoned. A single subject turns to different alter-personalities as a way to cope with pervasive inner conflict while at the same time hiding contradictory impulses from herself.     

Psychological distress associated with domestic violence in Northern Ireland

Several studies have noted an association between domestic violence and psychological distress. However, little empirical work has examined behavioral and psychological difficulties, especially with reference to dissociation and guilt, in victims of domestic violence in Northern Ireland. In addition, childhood abuse history has tended not to be assessed in studies conducted in the Province. Using measures designed to assess behavioral and psychological difficulties that are problematic to self and/or others (that is, Brief Symptoms Inventory, General Health Questionnaire, Guilt Inventory), dissociation (that is, Dissociative Experiences Scale, Peritraumatic Dissociative Experiences Questionnaire) and trauma (that is, Traumatic Experiences Checklist), the current study assessed Northern Irish victims of domestic violence from shelter-type accommodation (N=33) and a comparison sample of women from the general population (N=33). The domestic violence group displayed significantly more psychological difficulties, including higher depression, anxiety and dissociation scores. Dissociative episodes at the time of an assault were related to higher on-going dissociative experiences. Finally, the domestic violence sample reported more emotional, physical, and sexual abuse in childhood than the comparison group. Despite the difficulty generalizing from victims of domestic violence in shelter-type accommodation to all victims of spousal abuse, the current results highlight the increased levels of psychological distress in those exposed to abuse by their partner.     

The effect of emotional context on cognitive inhibition and attentional processing in dissociative identity disorder

In light of previous research, the current study tested the hypothesis that dissociative identity disorder (DID) would be characterised by effective cognitive inhibitory functioning when tested in a neutral context, but weakened inhibition when tested in an emotionally negative context. Using a negative priming task (i.e. the flanker task) to assess inhibitory ability 11 DID, 11 depressed, and 11 general population participants were tested in the two differing experimental contexts. The contexts were manipulated by instructions and word stimuli, and following the completion of this task participants completed the Dissociative Experiences Scale and the Schizotypal Personality Scale. DID participants displayed a greater degree of self-reported anxiety in the negative context and as expected displayed a reduction in inhibition in this context but not in the neutral context. The degree of negative priming for the depressed and general population samples remained stable across contexts as did their anxiety levels. The DID sample displayed slower response times to negative compared to neutral words but this attentional bias was not evident for the two comparison groups. The relationship between increased arousal, inhibitory functioning, dissociation and information processing in DID is discussed.     

From “It's Not Me” to “It Was Me,After All”: A Case Presentation of a Patient Diagnosed with Dissociative Identity Disorder

In cases of extreme childhood trauma associated with abuse and neglect, one's sense of self is seriously compromised. Attachment patterns, symptoms, defensive operations, and character formation will differ depending upon the level of interference and impingement. When repeated trauma occurs in early childhood, the dissociative response may become the first line of defense for the person to rely upon. In its most severe form, patients are diagnosed with Dissociative Identity Disorder (DID). This paper addresses the case of a woman diagnosed with DID. It describes the restoration of a cohesive sense of self from the eight parts of a dissociated and fragmented self in the course of therapy. The clinical case material presented is that of the child part of her, known as Lucy. Her treatment resulted in the integration of the “it's not me!” self to the patient's knowledge that “it was me, after all.”     

Gender and individualistic vs. collectivist bases for notions about the self

This article provides a critique of traditional psychological theories of the self that emphasize autonomy, separation, and independence, and ignore the inherently social character of the self Evidence from an empirical investigation of selected experiences of 84 white adult women and men who evidence two different notions of the self (autonomous individualism and social individuality) suggest that the culturally dominant notion of the self, rooted in assumptions of autonomy, independence, and separation, is but one orientation to the self A contrasting notion, social individuality, reflects a dialectical understanding of individuality and sociality grounded in an experience of social relations characterized by inequalities of power Preliminary research suggests that differences between women's and men's notions of the self are grounded in their different experiences of power These findings support a larger argument that research on the self in psychology must be grounded in an analysis of material social reality and reflect the dialectical relation of individuality and sociality     

Psychological and physiological responses to stress: The right hemisphere and the hypothalamo-pituitary-adrenal axis,an inquiry into problems of human bonding

In addition to repeated reexperiencing of the event, the delayed effects of severe psychological trauma, i.e., post traumatic stress disorder (PTSD), present a paradoxical mix of symptoms. There is enhancement of the self-preservative catecholamine states; anger and fear with a contrasting sense of meaninglessness and a blunting of the emotional responses of the attachment behavior so critical for species preservation. Hormonally, there is a striking separation of the catecholamine response, which stays elevated and that of the hypothalamo-pituitary-adrenal (HPA) axis, which may remain at normal levels. Pathophysiologically, the reexperiencing of the trauma and the arousal may be associated with dysfunction of the locus coeruleus, amygdala and hippocampal systems. This article explores the consequences of an additional dysfunction: a dissociation of the hemispheres that appears to be responsible for the alexithymic avoidance and failure of the cortisol response that so often follow severe psychological trauma. There is neurophysiological evidence that the left and right hemispheres subserve different emotional sets that correspond to “control” and “appraisal,” i.e., very approximately to the self and species preservative behavioral complexes, respectively. Several studies point to physiological dissociation of hemispheric functions during alexithymia. This raises the question: What has been lost if in this condition the right side no longer fully contributes to integrated cerebral function? Right hemispheric damaged children lose critical social skills and in adults the related sense of familiarity critical for bonding is lost. Such losses of social sensibilities may account for the lack of empathy and difficulties with bonding found in sociopathy and borderline personality: conditions now believed to result from repeated psychological trauma during development. On the other hand, systems that promote right hemispheric contributions provide solacing access to a “Higher Power.” They also appear to protect against socially disordered behavior, substance abuse, the failure of the HPA axis and some aspects of the pathophysiology of chronic disease.     

Cognitive Complexity and Dissociative Identity Disorder

Thirteen patients with dissociative identity disorder (DID), 13 with other mental disorders, and 10 nondiagnosed comparison participants were given individual grids. Results showed that displaying alternate personalities did not portend a more multidimensional level of thinking. Instead, the nonclinical comparison group had the greater degree of complexity in comparison to both clinical groups. A notable clinical observation was that DID patients, as compared to non-DID participants, had a greater understanding and speed in completing the grid. Findings are discussed in terms of the advantages of personal construct theory for conceptualizing the construct of dissociation.     

Evaluating the Unified Protocol in the Treatment of Dissociative Identify Disorder

The Unified Protocol for the Transdiagnostic Treatment of Emotional Disorders (UP; Barlow, Allen, & Choate, 2004) is a transdiagnostic cognitive behavior therapy for emotional disorders that addresses mood, anxiety, somatoform, and borderline personality disorders. Patients diagnosed with dissociative identity disorder (DID) form a nontrivial subset of patients. Extant treatment guidelines (ISSTD, 2011) emphasize the need to strive for fusion of identities (i.e., the creation of a unified sense of self). In contrast, the UP strives to inculcate an array of adaptive emotion skills, including cognitive reappraisal, emotional awareness, and affect tolerance, prior to planned exposure to traumatic memories. In this study, we provide the first assessment of the effectiveness of the UP with 5 individuals diagnosed with DID and co-occurring disorders and symptoms tracked at multiple time points. After 18–22 sessions, 4 patients exhibited significant reductions in anxiety, depression, and dissociative symptoms, and increases in emotional regulation, with significant improvements in symptomatology maintained after follow-ups of 1, 3, and 6 months. A fifth participant with prominent suicidal ideation was treated for 42 sessions and achieved comparable reductions in symptoms. None of the patients met criteria for DID or any other disorder at 6-month follow-up.     

Toward an etiology of dissociative identity disorder: a neurodevelopmental approach.

This article elaborates on Putnam's "discrete behavioral states" model of dissociative identity disorder (Putnam, 1997) by proposing the involvement of the orbitalfrontal cortex in the development of DID and suggesting a potential neurodevelopmental mechanism responsible for the development of multiple representations of self. The proposed "orbitalfrontal" model integrates and elaborates on theory and research from four domains: the neurobiology of the orbitalfrontal cortex and its protective inhibitory role in the temporal organization of behavior, the development of emotion regulation, the development of the self, and experience-dependent reorganizing neocortical processes. The hypothesis being proposed is that the experience-dependent maturation of the orbitalfrontal cortex in early abusive environments, characterized by discontinuity in dyadic socioaffective interactions between the infant and the caregiver, may be responsible for a pattern of lateral inhibition between conflicting subsets of self-representations which are normally integrated into a unified self. The basic idea is that the discontinuity in the early caretaking environment is manifested in the discontinuity in the organization of the developing child's self.     

The possessions at Loudun: tracking the discourse of dissociation

Embedded in the history of dissociation is the best known case of possession in European history, the 17^th century possessions at Loudun, France (1632‐1638). The exorcisms and the trial drew crowds from all over Europe, the outcome prefiguring the direction in which the Western science of mind would be carried. The published debate about the possessed and obsessed Ursuline nuns of Loudun spans four centuries. One can track how theorizing about dissociation changed over time, with psychological contributions by Jean Martin Charcot, Georges Gilles de la Tourette, Pierre Janet, Michel Foucault and Michel de Certeau. Freud's psychoanalytic notion of demonological neurosis emphasized defensive strategies and a diabolic parody of adulthood. Jung's concepts of demonism and possession highlighted dissociated complexes that assimilate the ego and unseat the self, rendering a life ‘provisional’. Dissociation as possession provides a through‐line in Jung's Collected Works, from his 1902 dissertation to one of the last essays he wrote, in 1961. Within the context of psychotherapy, therapists and patients work towards psychological containment, consciously reorienting themselves to the presence of unconscious factors, personifying, embodying and thereby incorporating images of dissociated Otherness into the experience of selfhood.     

SELF OR NO-SELF? CONVERGING PERSPECTIVES FROM NEUROPSYCHOLOGY AND MYSTICISM

Abstract. The nature of self is examined in relation to psychological observations which reveal some form of dissociation of knowledge from consciousness. Such dissociations are apparent in cases of blindsight, and amnesic patients displaying implicit memory effects, among others. While amnesic patients, for example, are unable consciously to recall material previously presented, such material does influence subsequent physiological and psychological processes. Thus, it is not the memories themselves that have been lost, but the ability to make conscious connection to them. In attempting to account for such observations, theoreticians generally have posited some kind of "consciousness system" that may become dissociated from brain modules dealing with specific processing.
It is argued here that a view of self along the lines of the Buddhist concepts of no-self and the conditioned nature of "I" introduces a more parsimonious perspective on the neuropsychological data. A theory of the nature of self is presented that constitutes a synthesis between key ideas drawn from Buddhist and other mainly mystical traditions and the scientific observations in psychology. Central to this theory is the role that the left hemisphere's interpreter (Gazzaniga 1985; 1988a; 1988b) plays in constructing a unified "I." This "I" is, in effect, a hypothesis that the mind generates to introduce some coherence into otherwise fragmentary mental elements. Although it appears to be the causal focus of the individual's behavior and experience, it is in fact a retrospective construction and not a true causal structure of the mind. This theoretical view is discussed in relation to various meanings of the term consciousness and also in relation to the relevant neuropsychological cases.     

Death, Asymmetry and the Psychological Self

Lucretius thought that we should be as indifferent to the time of our death as we are toward the time of our birth. This paper will critique the ways in which Thomas Nagel, Frederik Kaufman and Christopher Belshaw have appealed to a psychological notion of the self in an attempt to defend our asymmetric intuitions against Lucretius' claim. Four objections are marshalled against the psychological–self strategy: (1) the psychological notion of the self fails to capture all of our intuitions about selfhood; (2) some of the intuitions to which proponents of a psychological notion of the self appeal are drawn from irrelevant or misleading ethical and epistemological aspects of certain examples they consider; (3) the arguments developed on the basis of a psychological notion of the self do not answer Lucretius in the right way; and (4) the psychological–self explanation overlooks an important distinction between awareness–dependent and awareness–independent explanations. While the psychological–self explanation of the asymmetry in our attitudes toward the time of our birth and the time of our death may explain why Nagel, Kaufman and Belshaw have asymmetric attitudes, it fails to explain why most people have such attitudes.     

The Role of Religious Coping and Resilience in Individuals With Dissociative Identity Disorder

Survivors with dissociative identity disorder (DID) often report a history of traumatic events in their lives. Past studies indicated a link between trauma, resilience, and spiritual coping in both positive and negative aspects of a survivor's life. This article includes a review of existing literature salient to these constructs in relation to i ndividuals with DID, as well as results from a study examining the relationships between these constructs and individuals with DID (N = 52). Implications are discussed based on the findings for counselors treating individuals with DID.     

The mediating and moderating effects of differentiation of self on body mass index and depressive symptomatology among an American college sample

Differentiation of self – a core construct of Bowen's (Bowen, M. (1978). Family therapy in clinical practice. New York: Jason Aronson) family systems theory – was examined as a possible predictor of psychological health and physical health and as a mediator and moderator of the relation between overall functioning and psychological health and physical health. A total of 818 American college students participated (mean age?=?23.72, SD?=?4.79) in this study. Differentiation of self was correlated and was predictive of psychological health, as measured by the Beck depression inventory, and physical health, as measured by body mass index (BMI). A multivariate multiple regression model revealed that differentiation of self partially mediated the effects of overall functioning on depressive symptomatology and on BMI. Results from a hierarchical regression model showed that differentiation of self moderated the relation between overall functioning and depressive symptomatology but did not moderate the relation between overall functioning and BMI. Taken together, these preliminary findings provide initial evidence of the importance of the associations between family systemic factors (differentiation of self) and psychological and physical health factors among American college populations.     

Differentiation of Self, Stress, and Emotional Support as Predictors of Psychological Distress

We explored the relations among stress, emotional support, and differentiation of self from the family of origin as predictors of psychological distress in a sample of 200 college students. First, we investigated the discrepant findings of Murdock and Gore (Contemp Fam Ther 23: 319–335, 2004) and Skowron et al. (J Couns Dev 82: 69–78, 2004) regarding the relationships among stress, differentiation, and symptoms (a question of mediation vs. moderation). Second, we examined the role of emotional support in concert with stress and differentiation. When both stressful events and perceived stress were measured, differentiation of self was found to be a significant partial mediator of their effects on psychological distress. Emotional support was also found to partially mediate the relationship between differentiation of self and psychological distress. Differentiation of self partially mediated the relationship between actual and perceived stress, and perceived stress partially mediated the relationship between differentiation of self and psychological distress.     

The self and the soul

This paper explores the elusive and esoteric concepts of self and soul. After examining the psychological concept of self, as differentiated from ego, the authors present a unified theory of psychological, psychoanalytical and spiritual conceptualizations in light of Kabbalah, the Jewish mystical tradition. We suggest that understanding the self system (whether in object relations, intersubjective or interpersonal terms) is enhanced by the framework found in the Jewish mystical literature.     

Relationship Quality as Mediator of Forgiveness and Psychological Well-being among Transgressors in Romantic Relationships

Romantic relationships often blossom in college life. But relationships are not always a bed of roses. One may find themselves to be inflicting hurt towards their partner. The study aimed to explore the role of positive and negative relationship quality as the mediators of forgiveness (seeking and self) and psychological well-being in romantic relationships from the perspective of the transgressors. Data were collected from a sample of 119 college students in New Delhi, India, who have been in a romantic relationship for 6 months at least and who have hurt their partner in the past. They were administered the Seeking Forgiveness Questionnaire, Heartland Forgiveness Scale (self), Positive–Negative Relationship Quality Questionnaire and the Ryff Scales of Psychological Well-Being. The results showed positive relationship quality to be a mediator between forgiveness (seeking and self) and psychological well-being. Additional support for this relationship was provided by the insignificant role of negative relationship quality between forgiveness (seeking and self) and psychological well-being.     

Dissociative identity disorder and the sociocognitive model: recalling the lessons of the past.

In a recent article in this journal, D. H. Gleaves (1996) criticized the sociocognitive model (SCM; N. P. Spanos, 1994) of dissociative identity disorder (DID) and argued in favor of a posttraumatic model (PTM) in which DID is conceptualized as a consequence of childhood abuse and other traumatic events. The present authors demonstrate that (a) many of Gleaves's arguments were predicated on misunderstandings of the SCM, (b) scrutiny of the evidence regarding the psychopathology and assessment of DID raises questions concerning the PTM's conceptual and empirical underpinnings, (c) the treatment literature suggests that iatrogenic factors play an important role in the etiology of DID, and (d) the evidence linking child abuse to DID is more problematic than implied by Gleaves. The present authors conclude that Gleaves's analysis underemphasized the cultural manifestations of multiple role enactments and that the history of DID imparts a valuable lesson to contemporary psychotherapists.     

Chinese students in Japan: The mediator and the moderator between their personality and mental health

To clarify the influence of personality traits on the psychological acculturation of Chinese international students in Japan, the present study used three structuring questions: (a) What personality trait makes the students vulnerable to psychological distress? (b) What mediates between personality and psychological distress? (c) What buffers personality from psychological distress? The study examined personality traits (Harm‐Avoidance, HA; and Self‐Directedness, SD; two dimensions of the Temperament and Character Inventory), acculturation attitudes (integration, assimilation, separation, and marginalization), and the mental health (General Health Questionnaire (GHQ)‐30) of 253 Chinese students in Japan (17–30 years of age) using self‐report questionnaires. The hypotheses are: For the Chinese international students in Japan, (a) the individuals with high HA or low SD are more vulnerable to psychological distress; (b) the acculturation strategy mediates between personality (HA/SD) and mental health (GHQ); (c) social support can moderate the effect of personality on acculturation adaptation. The results show that the Chinese international students in Japan had higher GHQ scores compared to normative standards, and marginalization (a less adaptive strategy) was their second most preferred acculturation strategy, next to integration. Individuals with high HA or low SD were more likely to have a marginalization attitude and suffer from more psychological distress. The mediation effect of marginalization and the moderation effect of social support in life (SSL) between HA/SD and GHQ were confirmed. Most of the hypotheses were supported by the results. Explanations of these findings and their implication for acculturation adaptation are discussed.     

The correlates of psychological health among the Turkish unemployed: Psychological burden of financial help during unemployment

The purpose of this study is to examine the major determinants of psychological health during unemployment. With this in mind, 438 (17% female and 83% male) unemployed individuals were contacted through Turkey's State Employment Office. It was expected that the relationship between duration of unemployment and psychological wellbeing would be nonlinear. Additionally it was hypothesized that perceived social support would moderate the relationship between length of unemployment and psychological health. Further, we suggested that self‐esteem would be related to psychological health and moderate the relationship between length of unemployment and psychological health. The results supported the curvilinearity hypothesis of the relationship between unemployment duration and psychological health as measured by General Health Questionnaire. However, social support was not found to moderate the relationship between unemployment duration and psychological health. The hypothesis that self‐esteem would moderate the relationship between length of unemployment and psychological distress was not supported, although self‐esteem was a strong negative determinant of psychological distress during unemployment. Regression analysis showed that the best predictors of psychological health were self‐esteem, perceived social support and perceived adequacy of financial aid received from relatives. Interestingly, perceived adequacy of the financial aid was negatively related to psychological health. This result was contradictory with the previous literature pointing out that financial aid reduces the effects of poverty due to unemployment. The findings of this study are important since the relationship between unemployment duration and psychological health was nonlinear, indicating that relevant services should be especially careful to intervene to increase social support and self‐esteem during these critical times. The other results and limitations are discussed.