Distinguishing simulated from genuine dissociative identity disorder on the MMPI-2.

Abstract

Due to high elevations on validity and clinical scales on personality and forensic measures, it is challenging to determine if individuals presenting with symptoms of dissociative identity disorder (DID) are genuine or not. Little research has focused on malingering DID, or on the broader issue of the profiles these patients obtain on the Minnesota Multiphasic Personality Inventory (MMPI-2), despite increasing awareness of dissociation. This study sought to characterize the MMPI-2 profiles of DID patients and to determine the utility of the MMPI-2 in distinguishing DID patients from uncoached and coached DID simulators. The analyses revealed that Infrequency, Back Infrequency, and Infrequency-Psychopathology (Fp) distinguished simulators from genuine DID patients. Fp was best able to discriminate simulated DID. Utility statistics and classification functions are provided for classifying individual profiles as indicative of genuine or simulated DID. Despite exposure to information about DID, the simulators were not able to accurately feign DID, which is inconsistent with the iatrogenic/sociocultural model of DID. Given that dissociation was strongly associated with elevations in validity, as well as clinical scales, including Scale 8 (i.e., Schizophrenia), considerable caution should be used in interpreting validity scales as indicative of feigning, and Scale 8 as indicative of schizophrenia, among highly dissociative individuals.

Is it Trauma‐ or Fantasy‐based? Comparing dissociative identity disorder, post‐traumatic stress disorder, simulators, and controls

“…The SIMS includes subscales assessing amnesia as well as affective, psychotic, and neurological symptoms. Although affective, psychotic and neurological symptoms may be rare in some patient groups, they are well documented as common symptoms among individuals with DID . For example, individuals with DID have many intrusion symptoms that Schneider would have described as classic symptoms of schizophrenia and several studies have documented that the first‐rank symptoms for schizophrenia are as common in DID .…”

“…In contrast, the Fantasy Model , also referred to as the sociocognitive or non‐trauma‐related model , posits that dissociation and DID are related to enactment, sleep disturbances, suggestive psychotherapy, and/or sociocultural influences and are mediated by high suggestibility and fantasy proneness. The Fantasy Model states that DID can easily be simulated, but several studies comparing DID simulators to individuals with genuine DID have found that groups can be distinguished, contradicting the Fantasy Model . On the other hand, some studies examining differences on psychological measures found that DID‐simulating healthy controls can imitate some of the most obvious and well‐known symptoms associated with DID such as psychoform dissociation, including phenomena such as amnesia, loss of control, and identity confusion, yet simulators fail to adequately present the subtle and less well‐known symptoms and associated features of DID .…”

“…The Fantasy Model states that DID can easily be simulated, but several studies comparing DID simulators to individuals with genuine DID have found that groups can be distinguished, contradicting the Fantasy Model . On the other hand, some studies examining differences on psychological measures found that DID‐simulating healthy controls can imitate some of the most obvious and well‐known symptoms associated with DID such as psychoform dissociation, including phenomena such as amnesia, loss of control, and identity confusion, yet simulators fail to adequately present the subtle and less well‐known symptoms and associated features of DID . For example, a measure of symptom over reporting was best able to discriminate simulated DID .…”

“…On the other hand, some studies examining differences on psychological measures found that DID‐simulating healthy controls can imitate some of the most obvious and well‐known symptoms associated with DID such as psychoform dissociation, including phenomena such as amnesia, loss of control, and identity confusion, yet simulators fail to adequately present the subtle and less well‐known symptoms and associated features of DID . For example, a measure of symptom over reporting was best able to discriminate simulated DID . Thus far, these studies have provided support for the validity of DID as a diagnosis that cannot be easily imitated on psychological testing.…”

Chronic complex dissociative disorders and borderline personality disorder: disorders of emotion dysregulation?

“…In a study of 53 DID patients’ MMPI-2 [ 119 ] profiles, the highest elevation occurred on scale Schizophrenia (8) with additional marked elevations (>70 T) on scales Depression (2), Paranoia (4), Psychopathic Deviate (6), and Psychasthenia (7) which measures anxiety [ 120 ]. The DID Schizophrenia-Depression- code type has been found in previous DID samples [ 121 ], although Schizophrenia combined with Paranoia or Psychopathic Deviate (due to family discord and self-alienation, rather than problems with authority) are also common [ 122 – 125 ].…”