Revisiting the etiological aspects of dissociative identity disorder: a biopsychosocial perspective

Abstract

Dissociative identity disorder (DID) is a chronic post-traumatic disorder where developmentally stressful events in childhood, including abuse, emotional neglect, disturbed attachment, and boundary violations are central and typical etiological factors. Familial, societal, and cultural factors may give rise to the trauma and/or they may influence the expression of DID. Memory and the construction of self-identity are cognitive processes that appear markedly and centrally disrupted in DID and are related to its etiology. Enduring decoupling of psychological modes may create separate senses of self, and metamemory processes may be involved in interidentity amnesia. Neurobiological differences have been demonstrated between dissociative identities within patients with DID and between patients with DID and controls. Given the current evidence, DID as a diagnostic entity cannot be explained as a phenomenon created by iatrogenic influences, suggestibility, malingering, or social role-taking. On the contrary, DID is an empirically robust chronic psychiatric disorder based on neurobiological, cognitive, and interpersonal non-integration as a response to unbearable stress. While current evidence is sufficient to firmly establish this etiological stance, given the wide opportunities for innovative research, the disorder is still understudied. Comparison of well-selected samples of DID patients with non-dissociative subjects who have other psychiatric disorders would further delineate the neurobiological and cognitive features of the disorder, whereas genetic research on DID would further illuminate the interaction of the individual with environmental stress. As such, DID may be seen as an exemplary disease model of the biopsychosocial paradigm in psychiatry.

Dissociative identity disorder: out of the shadows at last?

“…Supporters of two diametrically opposed views have engaged in passionate debate for decades: 1 the trauma model states that DID is a severe form of post-traumatic stress disorder (PTSD) originating in severe and chronic (childhood) traumatisation, whereas the fantasy model postulates that DID is predominately due to suggestion and enactment and is facilitated by high levels of fantasy proneness and suggestibility. Although the trauma versus fantasy debate has evolved and aetiological research has broadened in the past few decades, 2 there are several reasons why the fantasy model continues to appeal to clinicians. One reason is that information in undergraduate and graduate textbooks about trauma and dissociation is inadequate or simply wrong, because (a) it is often based on experimental research in non-clinical samples, (b) it is not fully based on scientific research, (c) it contains unbalanced discussions about the detrimental impact of childhood traumatisation and (d) it disregards empirical evidence showing a relationship between dissociation and antecedent trauma.…”

Amnesia among Indigenous Australians

“…Recent research into dissociative identity disorders supports the finding that highly stressful events during childhood development produce a neurological response to intolerable stress which results in the deconstruction of self-identity [51]. Stress-induced trauma may arise from physical and emotional abuse or neglect, disturbed attachment, and boundary violations with the resultant effect amplified as a result of familial, societal and cultural factors [52].…”

“…Stress-induced trauma may arise from physical and emotional abuse or neglect, disturbed attachment, and boundary violations with the resultant effect amplified as a result of familial, societal and cultural factors [52]. As a biopsychosocial concept, dissociative identity disorder has been validated as a chronic psychiatric disorder arising from intolerable stress and trauma grounded on interpersonal non-assimilation, cognitive and neurobiological responses and as such warrants further comparative research [51]. DOI: http://dx.doi.org/10.5772/intechopen.89728…”

“…Frequently, the correlation between a patient's symptoms and traumatic experiences are not explored in depth as existing diagnostic tools are used to analyze and problem-solve which may only result in partial treatments [44]. Often trauma is treated by prescribing medicines for insomnia, anxiety and depression without understanding the etiology of the trauma condition [12,51,52]. There is also an increase in interventions from agencies in relation to emotional abuse, neglect and exposure to domestic violence and the need to mitigate risk to children.…”

A Strange Case of Dissociative Identity Disorder: Are There Any Triggers?

“…DID also includes the unexplained loss of personal information from one's memory [ 1 ]. The estimated DID prevalence around the globe is about 5% among the inpatient psychiatric population, 2%–3% among outpatients, and 1% in the general population [ 7 - 8 ].…”