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.     

Perceptual and conceptual priming in patients with dissociative identity disorder

The present study examined implicit memory transfer in patients with dissociative identity disorder (DID). To determine priming impairments in DID, we included both several perceptual priming tasks and a conceptual priming task using neutral material. We tested a large sample of DID patients (n = 31), in addition to 25 controls and 25 DID simulators, comparable on sex, age, and education. Controls replicated conceptual priming results of Vriezen, Moscovitch, and Bellos (1995) by showing that conceptual priming seems to require the formation of domain-specific semantic representations, denoting either sensory or functional object attributes. We extended a study performed by Schacter, Cooper, and Delaney (1990) by demonstrating priming for impossible object using the sensitive priming index of response times. The simulators in the study were not able to simulate interidentity amnesia on the implicit memory tasks employed. Partly in contrast to participants in previous studies, DID patients showed evidence of perceptual priming as well as conceptual priming comparable to that of controls. DID patients thus displayed normal implicit memory performance.     

Overvaluation of shape and weight in binge eating disorder and overweight controls: refinement of a diagnostic construct

Debate continues regarding the nosological status of binge eating disorder (BED) as a diagnosis as opposed to simply reflecting a useful marker for psychopathology. Contention also exists regarding the specific criteria for the BED diagnosis, including whether, like anorexia nervosa and bulimia nervosa, it should be characterized by overvaluation of shape/weight. The authors compared features of eating disorders, psychological distress, and weight among overweight BED participants who overvalue their shape/weight (n=92), BED participants with subclinical levels of overvaluation (n=73), and participants in an overweight comparison group without BED (n=45). BED participants categorized with clinical overvaluation reported greater eating-related psychopathology and depression levels than those with subclinical overvaluation. Both BED groups reported greater overall eating pathology and depression levels than the overweight comparison group. Group differences existed despite similar levels of overweight across the 3 groups, as well as when controlling for group differences in depression levels. These findings provide further support for the research diagnostic construct and make a case for the importance of shape/weight overvaluation as a diagnostic specifier.     

Interidentity amnesia for neutral,episodic information in dissociative identity disorder

Interidentity amnesia is considered a hallmark of dissociative identity disorder (DID) in clinical practice. In this study, objective methods of testing episodic memory transfer between identities were used. Tests of both recall (interference paradigm) and recognition were used. A sample of 31 DID patients was included. Additionally, 50 control subjects participated, half functioning as normal controls and the other half simulating interidentity amnesia. Twenty-one patients subjectively reported complete one-way amnesia for the learning episode. However, objectively, neither recall nor recognition scores of patients were different from those of normal controls. It is suggested that clinical models of amnesia in DID may be specified to exclude episodic memory impairments for emotionally neutral material.     

Interidentity memory transfer in dissociative identity disorder

Controversy surrounding dissociative identity disorder (DID) has focused on conflicting findings regarding the validity and nature of interidentity amnesia, illustrating the need for objective methods of examining amnesia that can discriminate between explicit and implicit memory transfer. In the present study, the authors used a cross-modal manipulation designed to mitigate implicit memory effects. Explicit memory transfer between identities was examined in 7 DID participants and 34 matched control participants. After words were presented to one identity auditorily, the authors tested another identity for memory of those words in the visual modality using an exclusion paradigm. Despite self-reported interidentity amnesia, memory for experimental stimuli transferred between identities. DID patients showed no superior ability to compartmentalize information, as would be expected with interidentity amnesia. The cross-modal nature of the test makes it unlikely that memory transfer was implicit. These findings demonstrate that subjective reports of interidentity amnesia are not necessarily corroborated by objective tests of explicit memory transfer.     

The discriminative validity of a phallometric test for pedophilic interests among adolescent sex offenders against children

The authors examined the responses of adolescent sex offenders against children on a phallometric test of pedophilic interests. Participants were 40 adolescent sex offenders against children, 75 young adult sex offenders against children, and 39 young adult comparison participants. The responses of adolescents with female victims resembled those of comparison participants; adolescents with any male victims had larger relative responses to child stimuli than comparison participants. Young adult offenders, regardless of victim sex, had larger relative responses to child stimuli than comparison participants. Using a cut score of 0 (indicating equal or greater arousal to children than to adults), sensitivity was 42% for adolescents with any male victims, and specificity was 92% for the comparison participants. Results suggest phallometric testing can identify pedophilic interests among these adolescent sex offenders.     

Procedural memory in dissociative identity disorder: when can inter-identity amnesia be truly established?

In a serial reaction time task, procedural memory was examined in Dissociative Identity Disorder (DID). Thirty-one DID patients were tested for inter-identity transfer of procedural learning and their memory performance was compared with 25 normal controls and 25 controls instructed to simulate DID. Results of patients seemed to indicate a pattern of inter-identity amnesia. Simulators, however, were able to mimic a pattern of inter-identity amnesia, rendering the results of patients impossible to interpret as either a pattern of amnesia or a pattern of simulation. It is argued that studies not including DID-simulators or simulation-free memory tasks, should not be taken as evidence for (or against) amnesia in DID.     

Illness perception in individuals with atopic dermatitis

Accumulating evidence suggests that in order to understand and respond to the difficulties presented by illness, patients construct their own "common sense" cognitive model of illness. This study set out to examine self-help group members, and students' beliefs about their atopic dermatitis (AD) and to investigate their relationship with symptom report and clinical and demographic variables. A total of 284 participants with AD undertook a self-assessment of their disease severity and completed the Revised Illness Perception Questionnaire. The most frequent symptoms associated with AD were itching, sleep difficulties and pain. The most commonly reported triggers of AD were stress, hereditary factors and emotional state. Over 75% of participants believed that their condition would be chronic. Self-help group members reported more significant consequences of the condition, a greater emotional impact, while the student group felt they had more personal control of their AD. Multiple regression analyses indicated that illness beliefs, in particular perceived consequences associated with AD and personal control, accounted for a significant proportion of the variance in emotional response to the condition. This study suggests that participants' beliefs and emotional response are more strongly associated with the meaning they ascribe to their condition rather than its severity.     

Current Treatment Strategies for Dissociative Identity Disorders in Adult Sexual Abuse Survivors

SUMMARY

During the past decade, increasing numbers of clinicians and researchers have suggested that the dissociative disorders, including dissociative identity disorder (DID), may be more prevalent than previously hypothesized. The “rediscovery” of DID is due, in part, to the recognition that early childhood trauma in conjunction with the propensity to dissociate, are etiologic factors for the development of DID. The purpose of this article is to raise clinical consciousness regarding DID, discuss the definition and etiology of the dissociative disorders, their assessment, and an approach to treatment of the sexual abuse survivor who has DID. This treatment program, while integrating some of the techniques recommended by others, is unique in its step-by-step flexible organization as well as its multifaceted format. The author's experience to date suggests that the sooner that a dissociative disorder can be identified in the adult sexual abuse survivor client, the more rapid the therapeutic progress.     

A critical evaluation of cognitive inhibition in dissociative identity disorder as inferred by negative priming in the flanker task: Limitations and the episodic retrieval alternative

Studies examining negative priming in dissociative identity disorder (DID) using the flanker task have reported emotional context effects. Significant negative priming is evident when individuals with DID are assessed in a context deemed emotionally neutral, while in contexts designed to elevate anxiety, DID samples display reduced negative priming. Limitations and considerations are discussed around statistical power, generalizability and reliability, and the use of diagnostic groups over specific clinical symptoms. The negative priming findings in this growing body of work have been interpreted with reference to the functioning of cognitive inhibitory mechanisms. Explored is how the episodic retrieval account of negative priming, with its reliance on memory mechanisms, could account for the DID findings. Encoding and retrieval possibilities are discussed and it is concluded that a failure to encode the prime trial distractor stimulus, in contexts of heightened anxiety, could explain the experimental findings from an episodic retrieval perspective.     

Memory transfer for emotionally valenced words between identities in dissociative identity disorder

The present study aimed to determine interidentity retrieval of emotionally valenced words in dissociative identity disorder (DID). Twenty-two DID patients participated together with 25 normal controls and 25 controls instructed to simulate DID. Two wordlists A and B were constructed including neutral, positive and negative material. List A was shown to one identity, while list B was shown to another identity claiming total amnesia for the words learned by the first identity. The identity claiming amnesia was tested for intrusions from list A words into the recall of words from list B and recognition of the words learned by both identities. Test results indicated no evidence of total interidentity amnesia for emotionally valenced material in DID. It is argued that dissociative amnesia in DID may more adequately be described as a disturbance in meta-memory functioning instead of an actual retrieval inability.     

Experimental Construct Validity of the Outcomes of Study Skills Training and Career Counseling as Treatments for the Retention of At-Risk Students

The authors evaluated the separate and combined effects of study skills training and career counseling on student retention. Participants who were at high risk for dropping out of college were randomly assigned to one of four treatment or control conditions. The study-skills-alone treatment had a significant impact on retention; all of these participants continued their enrollment in the following two semesters. Career-counseling-alone and a combined (study skills plus career counseling) treatment did not register significant effects. Participants who received the study-skills-alone treatment also achieved significantly greater academic success; 88% had grade point averages (GPAs) equal to or greater than 2.0, whereas most other treatment and control participants had GPAs lower than 2.0 and were placed on academic probation. Issues relevant to the construct validity of these changes are discussed.     

The unification of consciousness: Approaches to the healing of dissociation

This study examines the process of unifying consciousness as described in the Christian mystical tradition and in the psychological treatment of dissociative identity disorder (DID). A comparison of the experience of the self in the contemplative and the DID patient is also undertaken to emphasize points of continuity. The present analysis proposes that differentiating first-order dissociation (separation from a divine being or source) from second-order dissociation (separation from parts of one's own self and experiences) can preserve the insights gathered from both spiritual and psychological perspectives.     

Directed forgetting between,but not within,dissociative personality states

To investigate amnesia between identities in dissociative identity disorder (DID), the authors assessed explicit and implicit memory performance on a directed-forgetting task in 12 DID patients who switched from one state to an "amnesic" state between presentation and memory testing. DID patients were instructed either to remember or to forget neutral and emotional words. Besides an overall decrease in explicit memory, patients demonstrated selective forgetting of to-be-forgotten, but not of to-be-remembered words in the amnesic state. Patients did not exhibit any directed forgetting within the same state. Implicit memory was fully preserved across states. Independent of state, patients recalled more emotional than neutral information. These results may extend the conceptualization of memory processes in DID, suggesting an important role for retrieval inhibition.     

Follow-up of coping skills training in adults with sickle cell disease: analysis of daily pain and coping practice diaries.

This study examined the 3-month follow-up effects of a pain coping skills intervention in African American adults with sickle cell disease. Sixty-seven participants were randomly assigned to either a coping skills condition or a disease-education control condition. Multivariate analyses applied to summary measures of coping, laboratory pain perception, and clinical measures indicated that participants in the coping intervention reported significantly lower laboratory pain and significantly higher coping attempts at 3-month follow-up in comparison with the control condition. Multilevel random effects models applied to prospective daily diaries of daily pain, health care contacts, and coping practice indicated that on pain days when participants practiced their strategies, they had less major health care contacts in comparison with days when they did not use strategies.     

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.”     

Upward and downward physical appearance comparisons: Development of scales and examination of predictive qualities

Despite good theoretical and empirical rationale for assessing tendencies to make upward and downward physical appearance comparisons no measure for these specific constructs exists. The present work developed and tested the psychometric properties of upward and downward physical appearance comparison scales. The scales were administered to participants (N = 224) along with measures of general appearance comparison tendencies, body image, disordered eating, Antifat and Antigay attitudes. The scales displayed good psychometric properties. Importantly, the upward but not downward physical appearance comparison scale predicted lower Appearance Evaluation and higher EAT-26 scores. Conversely, the downward but not upward physical appearance comparison scale predicted higher Appearance Evaluation and greater Antifat Attitudes (Dislike). The scales were unrelated to a nonappearance related construct. These new measures fill a gap in the literature and may be of benefit to researchers interested in body image, appearance concerns, eating disorders, social comparison, and obesity prejudice.     

An experimental investigation of the role of safety-seeking behaviours in the maintenance of panic disorder with agoraphobia.

This study evaluates the hypothesis that safety-seeking behaviours play an important role in maintaining anxiety because they prevent patients from benefiting from disconfirmatory experience. Patients suffering from panic disorder with agoraphobia carried out a behaviour test, closely followed by an experimental session, which included a brief (15 min) period of exposure during which participants either stopped or maintained within-situation safety-seeking behaviours. When the behaviour test was repeated within two days, patients who had stopped their safety-seeking behaviours during the experimental session showed a significantly greater decrease in catastrophic beliefs and anxiety than those who had maintained safety-seeking behaviour. This difference was also reflected in questionnaires measuring clinical anxiety. These results are consistent with the cognitive hypothesis.     

Child Sexual Abuse History and Feminine Gender-Role Identity

The association between child sexual abuse (CSA) and feminine gender-role identity was examined among 75 women with and 107 without a history of CSA. Undergraduates and hospital employees from a university in the Southern United States completed questionnaires on the internet. Three aspects of feminine identity were assessed, including how much participants identified with feminine versus masculine traits, endorsed stereotypes about women, and viewed themselves as meeting feminine self-standards. Participants with a history of CSA reported greater feminine self-discrepancy and endorsed more derogatory stereotypes about women than the comparison group. CSA was also linked to identifying with more feminine than masculine traits, but only among hospital employees. Results suggest that feminine identity is a meaningful construct to consider in the adjustment of CSA survivors.     

Effects of Worldview and Mortality Salience in Persuasion Processes

Individual differences in media effects research have yielded a trove of insights into how media content can have varying effects. One such variable is worldview—a philosophy of life that enables a person to make sense of one's experience—but the notion has largely been unexamined in media effects research. A person's worldview can moderate the way a persuasive message is processed—sometimes in the opposite direction of that intended by communicators. Building on the construct of worldview and terror management theory, two experiments (N = 149 and N = 151) examined the question with worldview as a measured variable and mortality salience as a two-level factor. Worldview had a main effect on global evaluations of ads, as participants who tended toward a relativist worldview had lower evaluations of the ads and lower behavioral intentions, while participants who tended toward a positivist worldview had higher evaluations of the ads and higher behavioral intentions. Also, mortality salience was found to moderate participants' worldview, presumably making their worldview more accessible to exert a greater influence. The importance of worldview as a construct in media effects research, as well as theoretical implications for persuasion and terror management theory, are discussed.