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

Vissia, Eline M.; Giesen, Mechteld E.; Chalavi, Sima; Nijenhuis, Ellert R. S.; Draijer, Nel; Brand, Bethany L.; Reinders, Antje A. T. S.

doi:10.1111/acps.12590

Cited by 70 publications

(74 citation statements)

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“…As expected, the areas affected included parietal and insular regions as well as the limbic‐prefrontal circuitry of the brain, previously shown to be implicated in emotion regulation in DID . DID is considered an early‐onset form of PTSD , and therefore, one could reasonably expect to find similarities in abnormality of cortical morphology. In fact, PTSD is accompanied by abnormalities in brain anatomy and connectivity, which are correlated with symptom severity .…”

Section: Discussionsupporting

confidence: 65%

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Neurodevelopmental origins of abnormal cortical morphology in dissociative identity disorder

Reinders

Chalavi

Schlumpf

et al. 2017

Acta Psychiatr Scand

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Objective To examine the two constitutes of cortical volume (CV), that is, cortical thickness (CT) and surface area (SA), in individuals with dissociative identity disorder (DID) with the view of gaining important novel insights into the underlying neurobiological mechanisms mediating DID. Methods This study included 32 female patients with DID and 43 matched healthy controls. Between‐group differences in CV, thickness, and SA, the degree of spatial overlap between differences in CT and SA, and their relative contribution to differences in regional CV were assessed using a novel spatially unbiased vertex‐wise approach. Whole‐brain correlation analyses were performed between measures of cortical anatomy and dissociative symptoms and traumatization. Results Individuals with DID differed from controls in CV, CT, and SA, with significantly decreased CT in the insula, anterior cingulate, and parietal regions and reduced cortical SA in temporal and orbitofrontal cortices. Abnormalities in CT and SA shared only about 3% of all significantly different cerebral surface locations and involved distinct contributions to the abnormality of CV in DID. Significant negative associations between abnormal brain morphology (SA and CV) and dissociative symptoms and early childhood traumatization (0 and 3 years of age) were found. Conclusions In DID, neuroanatomical areas with decreased CT and SA are in different locations in the brain. As CT and SA have distinct genetic and developmental origins, our findings may indicate that different neurobiological mechanisms and environmental factors impact on cortical morphology in DID, such as early childhood traumatization.

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Section: Discussionsupporting

confidence: 65%

“…Dissociative identity disorder (DID) is considered an early‐onset and chronic interpersonal trauma‐related disorder . For early‐onset interpersonal trauma‐related disorders, it is currently unknown how early traumatization affects the development of the brain and what particular aspect of the cortical neuroanatomy is most affected.…”

Section: Introductionmentioning

confidence: 99%

Neurodevelopmental origins of abnormal cortical morphology in dissociative identity disorder

Reinders

Chalavi

Schlumpf

et al. 2017

Acta Psychiatr Scand

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“…The questionnaire data were obtained as part of a larger study (Chalavi et al, 2015a(Chalavi et al, , 2015bVissia et al, 2016). Only female participants volunteered to participate, and data of three groups were included: individuals with DID (n = 17), individuals with PTSD (n = 16), and healthy controls (HC) (n = 16).…”

Section: Design and Participantsmentioning

confidence: 99%

“…DID is also under-diagnosed and the most disputed of psychiatric disorders (Reinders et al, 2019). Whether its aetiology is trauma-related, as described in a Trauma Model (TM) (Dalenberg et al, 2012), or related to fantasy proneness, which is referred to as the Fantasy Model (FM) (Dalenberg et al, 2012) (also known as the Sociocognitive model (Spanos, 1994)), is an ongoing debate Dalenberg et al, 2012Dalenberg et al, , 2014Lynn et al, 2014;Merckelbach, Lynn, & Lilienfeld, n.d.;Vissia et al, 2016). The TM for DID explains dissociation and identity fragmentation as a reaction to early and prolonged traumatizing experiences Vissia et al, 2016).…”

Section: Introductionmentioning

confidence: 99%

“…Whether its aetiology is trauma-related, as described in a Trauma Model (TM) (Dalenberg et al, 2012), or related to fantasy proneness, which is referred to as the Fantasy Model (FM) (Dalenberg et al, 2012) (also known as the Sociocognitive model (Spanos, 1994)), is an ongoing debate Dalenberg et al, 2012Dalenberg et al, , 2014Lynn et al, 2014;Merckelbach, Lynn, & Lilienfeld, n.d.;Vissia et al, 2016). The TM for DID explains dissociation and identity fragmentation as a reaction to early and prolonged traumatizing experiences Vissia et al, 2016). Consistent with this DID is associated with chronic emotional neglect, emotional abuse, physical abuse and neglect and/or sexual abuse starting in early childhood (Brand et al, 2009;Chalavi et al, 2015aChalavi et al, , 2015bHornstein & Putnam, 1992;Kluft, 1996;Nijenhuis, 2015).…”

Section: Introductionmentioning

confidence: 99%

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Sleep, trauma, fantasy and cognition in dissociative identity disorder, post-traumatic stress disorder and healthy controls: a replication and extension study

Dimitrova

Fernando

Vissia³

et al. 2020

European Journal of Psychotraumatology

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Background: Two aetiology models for dissociative identity disorder (DID) have been proposed, namely a childhood Trauma Model and an iatrogenic or Fantasy model. A recent study indicated that sleep disturbances underlie dissociative symptomatology. Objective: Our current study aims to test whether this finding can be replicated in an independent sample and to investigate if this finding still holds after correcting for childhood and adult traumatization. An experimental working memory task is included to investigate how sleep disturbance, traumatization, dissociation, and fantasy proneness impact cognitive functioning. Methods: Three groups of participants were includedindividuals with DID, individuals with post-traumatic stress disorder (PTSD), and matched healthy controls. Sleep disturbances were measured and compared between the groups along with measures of childhood and adult traumatization, psychoform and somatoform [psychological and somatic] dissociative symptoms, and fantasy proneness. Cognitive capacity was assessed using a working memory task. Results: When controlled for traumatic experiences, sleep disturbances did not predict dissociative symptoms. When controlled for sleep disturbance and fantasy proneness, childhood traumatization did predict dissociative symptoms. Psychoform dissociative symptoms correlated with traumatic experiences more than with fantasy proneness. Working memory performance was similar among the participating groups. Propensity to fantasy did not discriminate individuals with DID and PTSD, and was a weak predictor of dissociative symptoms. Conclusion: Whereas DID and PTSD are associated with sleep disturbances, these features do not statistically predict dissociative symptoms in these disorders when traumatic experiences are taken into account. Fantasy proneness is not excessive in DID and PTSD. Hence, we found no evidence that sleep disturbances, propensity to fantasy and abnormal working memory capacity explain dissociative symptoms in DID and PTSD. In sum, the relationship between sleep and dissociative symptoms disappeared when potentially traumatizing events were controlled for.

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Identity state‐dependent self‐relevance and emotional intensity ratings of words in dissociative identity disorder: A controlled longitudinal study

Strouza,

Lawrence,

Vissia

et al. 2023

Brain and Behavior

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IntroductionDissociative identity disorder (DID) is characterized by, among others, amnesic episodes and the recurrence of different dissociative identity states. While consistently observed in clinical settings, to our knowledge, no controlled research study has shown the degree to which different identity states report autobiographical knowledge over time. Hence, the current study investigates self‐relevance and emotional intensity ratings of words longitudinally.MethodsData of 46 participants were included: 13 individuals with DID, 11 DID‐simulating actors, and a control group of 22 paired individuals. Individuals with DID and DID simulators participated once in the neutral identity state (NIS) and once in the trauma‐related dissociative identity state (TIS). The control group paired 11 healthy controls with 11 participants with posttraumatic stress disorder (PTSD) as a NIS–TIS pair. Self‐relevance ratings of different word types were collected in a baseline and a follow‐up session, on average 6 weeks apart. A mixed ANOVA design was used to assess the effects of group, session, word type, and dissociative identity state.ResultsAll participants in TIS and individuals with DID in NIS rated self‐relevant trauma‐related words more negatively. In the NIS, the control group rated self‐relevant trauma‐related words as less negative, whereas the ratings of simulating actors were intermediate. There was no group‐dependent longitudinal effect for intensity ratings.ConclusionsThis study was the first to confirm clinical observations that self‐relevant and emotional processing are different between individuals with DID and controls, but consistent over time. Actors were unable to perfectly simulate DID. The finding that ratings of self‐relevant trauma‐related words differ between subgroups as included in the study is in line with clinical observations.

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

Cited by 70 publications

References 80 publications

Neurodevelopmental origins of abnormal cortical morphology in dissociative identity disorder

Neurodevelopmental origins of abnormal cortical morphology in dissociative identity disorder

Sleep, trauma, fantasy and cognition in dissociative identity disorder, post-traumatic stress disorder and healthy controls: a replication and extension study

Identity state‐dependent self‐relevance and emotional intensity ratings of words in dissociative identity disorder: A controlled longitudinal study

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