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Savard MA, Merlo R, Samithamby A, Paas A, Coffey EBJ. Approaches to studying emotion using physiological responses to spoken narratives: A scoping review. Psychophysiology 2024:e14642. [PMID: 38961524 DOI: 10.1111/psyp.14642] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/25/2023] [Revised: 06/07/2024] [Accepted: 06/12/2024] [Indexed: 07/05/2024]
Abstract
Narratives are effective tools for evoking emotions, and physiological measurements provide a means of objectively assessing emotional reactions - making them a potentially powerful pair of tools for studying emotional processes. However, extent research combining emotional narratives and physiological measurement varies widely in design and application, making it challenging to identify previous work, consolidate findings, and design effective experiments. Our scoping review explores the use of auditory emotional narratives and physiological measures in research, examining paradigms, study populations, and represented emotions. Following the PRISMA-ScR Checklist, we searched five databases for peer-reviewed experimental studies that used spoken narratives to induce emotion and reported autonomic physiological measures. Among 3466 titles screened and 653 articles reviewed, 110 studies were included. Our exploration revealed a variety of applications and experimental paradigms; emotional narratives paired with physiological measures have been used to study diverse topics and populations, including neurotypical and clinical groups. Although incomparable designs and sometimes contradictory results precluded general recommendations as regards which physiological measures to use when designing new studies, as a whole, the body of work suggests that these tools can be valuable to study emotions. Our review offers an overview of research employing narratives and physiological measures for emotion study, and highlights weaknesses in reporting practices and gaps in our knowledge concerning the robustness and specificity of physiological measures as indices of emotion. We discuss study design considerations and transparent reporting, to facilitate future using emotional narratives and physiological measures in studying emotions.
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Affiliation(s)
- Marie-Anick Savard
- Department of Psychology, Concordia University, Montreal, Quebec, Canada
- International Laboratory for Brain, Music and Sound Research (BRAMS), Montreal, Quebec, Canada
- Centre for Research on Brain, Language and Music (CRBLM), Montreal, Quebec, Canada
| | - Raphaëlle Merlo
- International Laboratory for Brain, Music and Sound Research (BRAMS), Montreal, Quebec, Canada
- Centre for Research on Brain, Language and Music (CRBLM), Montreal, Quebec, Canada
- École de Psychologie, Université Laval, Québec, Quebec, Canada
| | - Abiraam Samithamby
- Department of Psychology, Concordia University, Montreal, Quebec, Canada
- International Laboratory for Brain, Music and Sound Research (BRAMS), Montreal, Quebec, Canada
- Centre for Research on Brain, Language and Music (CRBLM), Montreal, Quebec, Canada
| | - Anita Paas
- Department of Psychology, Concordia University, Montreal, Quebec, Canada
- International Laboratory for Brain, Music and Sound Research (BRAMS), Montreal, Quebec, Canada
- Centre for Research on Brain, Language and Music (CRBLM), Montreal, Quebec, Canada
| | - Emily B J Coffey
- Department of Psychology, Concordia University, Montreal, Quebec, Canada
- International Laboratory for Brain, Music and Sound Research (BRAMS), Montreal, Quebec, Canada
- Centre for Research on Brain, Language and Music (CRBLM), Montreal, Quebec, Canada
- Montreal Neurological Institute (MNI), McGill University, Montreal, Quebec, Canada
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Dimitrova LI, Lawrence AJ, Vissia EM, Chalavi S, Kakouris AF, Veltman DJ, Reinders AATS. Inter-identity amnesia in dissociative identity disorder resolved: A behavioural and neurobiological study. J Psychiatr Res 2024; 174:220-229. [PMID: 38653030 DOI: 10.1016/j.jpsychires.2024.04.026] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/17/2023] [Revised: 04/08/2024] [Accepted: 04/15/2024] [Indexed: 04/25/2024]
Abstract
INTRODUCTION Dissociative identity disorder (DID) is characterised by, among others, subjectively reported inter-identity amnesia, reflecting compromised information transfer between dissociative identity states. Studies have found conflicting results regarding memory transfer between dissociative identity states. Here, we investigated inter-identity amnesia in individuals with DID using self-relevant, subject specific stimuli, and behavioural and neural measures. METHODS Data of 46 matched participants were included; 14 individuals with DID in a trauma-avoidant state, 16 trauma-avoiding DID simulators, and 16 healthy controls. Reaction times and neural activation patterns related to three types of subject specific words were acquired and statistically analysed, namely non-self-relevant trauma-related words (NSt), self-relevant trauma-related words from a trauma-avoidant identity state (St), and trauma-related words from a trauma-related identity state (XSt). RESULTS We found no differences in reaction times between XSt and St words and faster reaction times for XSt over NSt. Reaction times of the diagnosed DID group were the longest. Increased brain activation to XSt words was found in the frontal and parietal regions, while decreased brain activity was found in the anterior cingulate cortex in the diagnosed DID group. DISCUSSION The current study reproduces and amalgamates previous behavioural reports as well as brain activation patterns. Our finding of increased cognitive control over self-relevant trauma-related knowledge processing has important clinical implications and calls for the redefinition of "inter-identity amnesia" to "inter-identity avoidance".
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Affiliation(s)
- Lora I Dimitrova
- Department of Psychological Medicine, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK; Department of Psychiatry, Amsterdam UMC, Location VUmc, VU University Amsterdam, Amsterdam, the Netherlands
| | - Andrew J Lawrence
- Department of Psychological Medicine, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK
| | - Eline M Vissia
- Heelzorg, Centre for Psychotrauma, Zwolle, the Netherlands
| | - Sima Chalavi
- Research Center for Movement Control and Neuroplasticity, Department of Movement Sciences, KU Leuven, Leuven, Belgium
| | - Andreana F Kakouris
- Department of Psychosis Studies, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK
| | - Dick J Veltman
- Department of Psychiatry, Amsterdam UMC, Location VUmc, VU University Amsterdam, Amsterdam, the Netherlands
| | - Antje A T S Reinders
- Department of Psychological Medicine, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK.
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Callus E, Gallina E, Fernandez I. EMDR: dispelling the false memory creation myth in response to Otgaar et al. (2022a). Front Psychol 2024; 15:1366137. [PMID: 38689725 PMCID: PMC11058937 DOI: 10.3389/fpsyg.2024.1366137] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2024] [Accepted: 04/03/2024] [Indexed: 05/02/2024] Open
Affiliation(s)
- Edward Callus
- Clinical Psychology Service, IRCCS Policlinico San Donato, San Donato Milanese, Milan, Italy
- Department of Biomedical Sciences for Health, University of Milan, Milan, Italy
| | - Eugenio Gallina
- Centro di Ricerca e Studi in Psicotraumatologia (CRSP), Milan, Italy
| | - Isabel Fernandez
- Centro di Ricerca e Studi in Psicotraumatologia (CRSP), Milan, Italy
- Associazione EMDR Italia, Varedo, Italy
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Fani N, Guelfo A, La Barrie DL, Teer AP, Clendinen C, Karimzadeh L, Jain J, Ely TD, Powers A, Kaslow NJ, Bradley B, Siegle GJ. Neurophysiological changes associated with vibroacoustically-augmented breath-focused mindfulness for dissociation: targeting interoception and attention. Psychol Med 2023; 53:7550-7560. [PMID: 37144411 PMCID: PMC10755223 DOI: 10.1017/s0033291723001277] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/09/2022] [Revised: 03/06/2023] [Accepted: 04/13/2023] [Indexed: 05/06/2023]
Abstract
BACKGROUND Dissociative symptoms can emerge after trauma and interfere with attentional control and interoception; disruptions to these processes are barriers to mind-body interventions such as breath-focused mindfulness (BFM). To overcome these barriers, we tested the use of an exteroceptive augmentation to BFM, using vibrations equivalent to the amplitude of the auditory waveform of the actual breath, delivered via a wearable subwoofer in real time (VBFM). We tested whether this device enhanced interoceptive processes, attentional control and autonomic regulation in trauma-exposed women with dissociative symptoms. METHODS 65 women, majority (82%) Black American, aged 18-65 completed self-report measures of interoception and 6 BFM sessions, during which electrocardiographic recordings were taken to derive high-frequency heart rate variability (HRV) estimates. A subset (n = 31) of participants completed functional MRI at pre- and post-intervention, during which they were administered an affective attentional control task. RESULTS Compared to those who received BFM only, women who received VBFM demonstrated greater increases in interoception, particularly their ability to trust body signals, increased sustained attention, as well as increased connectivity between nodes of emotion processing and interoceptive networks. Intervention condition moderated the relationship between interoception change and dissociation change, as well as the relationship between dissociation and HRV change. CONCLUSIONS Vibration feedback during breath focus yielded greater improvements in interoception, sustained attention and increased connectivity of emotion processing and interoceptive networks. Augmenting BFM with vibration appears to have considerable effects on interoception, attention and autonomic regulation; it could be used as a monotherapy or to address trauma treatment barriers.
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Affiliation(s)
- Negar Fani
- Department of Psychiatry, Emory University, Atlanta, GA, USA
| | | | | | - Andrew P. Teer
- Department of Psychiatry, Emory University, Atlanta, GA, USA
| | | | | | - Jahnvi Jain
- Department of Psychiatry, Emory University, Atlanta, GA, USA
| | - Timothy D. Ely
- Department of Psychiatry, Emory University, Atlanta, GA, USA
| | - Abigail Powers
- Department of Psychiatry, Emory University, Atlanta, GA, USA
| | | | - Bekh Bradley
- Department of Psychiatry, Emory University, Atlanta, GA, USA
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Strouza AI, Lawrence AJ, Vissia EM, Kakouris A, Akan A, Nijenhuis ERS, Draijer N, Chalavi S, Reinders AATS. Identity state-dependent self-relevance and emotional intensity ratings of words in dissociative identity disorder: A controlled longitudinal study. Brain Behav 2023; 13:e3208. [PMID: 37721528 PMCID: PMC10570477 DOI: 10.1002/brb3.3208] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/13/2023] [Revised: 07/20/2023] [Accepted: 07/22/2023] [Indexed: 09/19/2023] Open
Abstract
INTRODUCTION Dissociative 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. METHODS Data 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. RESULTS All 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. CONCLUSIONS This 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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Affiliation(s)
- Aikaterini I. Strouza
- Department of Psychological Medicine, Institute of Psychiatry, Psychology & NeuroscienceKing's College LondonLondonUK
- Department of Psychiatry, Amsterdam UMC, Location VUmcVU University AmsterdamAmsterdamThe Netherlands
| | - Andrew J. Lawrence
- Department of Psychological Medicine, Institute of Psychiatry, Psychology & NeuroscienceKing's College LondonLondonUK
| | | | - Andreana Kakouris
- Department of Psychosis Studies, Institute of PsychiatryKing's College LondonLondonUK
| | - Ayse Akan
- Department of Psychosis Studies, Institute of PsychiatryKing's College LondonLondonUK
- North East London NHS Foundation TrustLondonUK
| | - Ellert R. S. Nijenhuis
- Clienia Littenheid AGPrivate Clinic for Psychiatry and PsychotherapyLittenheidSwitzerland
| | - Nel Draijer
- Department of PsychiatryVU University Medical CenterAmsterdamThe Netherlands
| | - Sima Chalavi
- Movement Control and Neuroplasticity Research Group, Department of Movement SciencesKU LeuvenLeuvenBelgium
| | - Antje A. T. S. Reinders
- Department of Psychological Medicine, Institute of Psychiatry, Psychology & NeuroscienceKing's College LondonLondonUK
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Poli A, Cappellini F, Sala J, Miccoli M. The integrative process promoted by EMDR in dissociative disorders: neurobiological mechanisms, psychometric tools, and intervention efficacy on the psychological impact of the COVID-19 pandemic. Front Psychol 2023; 14:1164527. [PMID: 37727746 PMCID: PMC10505816 DOI: 10.3389/fpsyg.2023.1164527] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2023] [Accepted: 08/07/2023] [Indexed: 09/21/2023] Open
Abstract
Dissociative disorders (DDs) are characterized by a discontinuity in the normal integration of consciousness, memory, identity, emotion, perception, bodily representation, motor control, and action. The life-threatening coronavirus disease 2019 (COVID-19) pandemic has been identified as a potentially traumatic event and may produce a wide range of mental health problems, such as depression, anxiety disorders, sleep disorders, and DD, stemming from pandemic-related events, such as sickness, isolation, losing loved ones, and fear for one's life. In our conceptual analysis, we introduce the contribution of the structural dissociation of personality (SDP) theory and polyvagal theory to the conceptualization of the COVID-19 pandemic-triggered DD and the importance of assessing perceived safety in DD through neurophysiologically informed psychometric tools. In addition, we analyzed the contribution of eye movement desensitization and reprocessing (EMDR) to the treatment of the COVID-19 pandemic-triggered DD and suggest possible neurobiological mechanisms of action of the EMDR. In particular, we propose that, through slow eye movements, the EMDR may promote an initial non-rapid-eye-movement sleep stage 1-like activity, a subsequent access to a slow-wave sleep activity, and an oxytocinergic neurotransmission that, in turn, may foster the functional coupling between paraventricular nucleus and both sympathetic and parasympathetic cardioinhibitory nuclei. Neurophysiologically informed psychometric tools for safety evaluation in DDs are discussed. Furthermore, clinical and public health implications are considered, combining the EMDR, SDP theory, and polyvagal conceptualizations in light of the potential dissociative symptomatology triggered by the COVID-19 pandemic.
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Childhood trauma in patients with Dissociative Identity Disorder: A systematic Review of Data from 1990 to 2022. EUROPEAN JOURNAL OF TRAUMA & DISSOCIATION 2022. [DOI: 10.1016/j.ejtd.2022.100310] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
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Reinders AATS, Dimitrova LI, Schlumpf YR, Vissia EM, Dean SL, Jäncke L, Chalavi S, Veltman DJ, Nijenhuis ERS. The elusive search for a biomarker of dissociative amnesia: an overstated response to understated findings? Psychol Med 2022; 52:2837-2845. [PMID: 35855668 DOI: 10.1017/s0033291722001660] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Affiliation(s)
- Antje A T S Reinders
- Department of Psychological Medicine, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK
| | - Lora I Dimitrova
- Department of Psychological Medicine, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK
- Department of Psychiatry, Amsterdam UMC, Location VUmc, VU University Amsterdam, Amsterdam, The Netherlands
| | - Yolanda R Schlumpf
- Division of Neuropsychology, Department of Psychology, University of Zurich, Zurich, Switzerland
- Clienia Littenheid AG, Private Clinic for Psychiatry and Psychotherapy, Sirnach, Switzerland
| | - Eline M Vissia
- Heelzorg, Centre for Psychotrauma, Zwolle, The Netherlands
| | - Sophie L Dean
- Department of Psychosis Studies, Institute of Psychiatry, King's College London, London, UK
| | - Lutz Jäncke
- Division of Neuropsychology, Department of Psychology, University of Zurich, Zurich, Switzerland
- Research Unit for Plasticity and Learning of the Healthy Aging Brain, University of Zurich, Zurich, Switzerland
| | - Sima Chalavi
- Movement Control and Neuroplasticity Research Group, Department of Movement Sciences, KU Leuven, Leuven, Belgium
| | - Dick J Veltman
- Department of Psychiatry, Amsterdam UMC, Location VUmc, VU University Amsterdam, Amsterdam, The Netherlands
| | - Ellert R S Nijenhuis
- Clienia Littenheid AG, Private Clinic for Psychiatry and Psychotherapy, Sirnach, Switzerland
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Al-Shamali HF, Winkler O, Talarico F, Greenshaw AJ, Forner C, Zhang Y, Vermetten E, Burback L. A systematic scoping review of dissociation in borderline personality disorder and implications for research and clinical practice: Exploring the fog. Aust N Z J Psychiatry 2022; 56:1252-1264. [PMID: 35152771 PMCID: PMC9511244 DOI: 10.1177/00048674221077029] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
Abstract
BACKGROUND Borderline Personality Disorder (BPD) is frequently complicated by the presence of dissociative symptoms. Pathological dissociation is linked with earlier and more severe trauma exposure, emotional dysregulation and worse treatment outcomes in Posttraumatic Stress Disorder and Dissociative Disorders, with implications for BPD. OBJECTIVE A systematic scoping review was conducted to assess the extent of current literature regarding the impact of dissociation on BPD and to identify knowledge gaps. METHODS Four electronic databases (MEDLINE, APA PsycINFO, EMBASE, CINAHL Plus) were searched, and English peer-reviewed studies with adults with BPD were included, following Preferred Reporting Items for Systematic reviews and Meta-Analysis (PRISMA) extension for scoping reviews (PRISMA-ScR) 2018 guidelines. RESULTS Most of the 70 included studies were observational (98%) with first authors from Germany (59%). Overall, dissociation was associated with increased BPD symptom severity, self-harm and reduced psychotherapy treatment response; findings regarding suicide risk were mixed. Dissociation was associated with working memory and cognitive deficits, decreased pain perception, altered body ownership, no substance abuse or the abuse of sedative substances, increased fantasy proneness, personality fragmentation, fearful attachment, dream anxiety, perceived stress and altered stress responses, increased cumulative body mass index, decreased water consumption, several neurological correlates and changes in gene expression. CONCLUSION BPD with significant dissociative symptoms may constitute a more severe and at-risk subgroup of BPD patients. However, there are significant research gaps and methodological issues in the area, including the possibility of unrecognized Dissociative Disorders in BPD study populations confounding results. Further studies are needed to better understand the impact of dissociation on BPD course and treatment, and to clarify the most appropriate assessment tools for clinical practice. In addition, interventional studies are needed to develop dissociation-specific BPD treatments to determine whether targeting dissociation in BPD can improve treatment outcomes.
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Affiliation(s)
- Huda F Al-Shamali
- Department of Psychiatry, University of Alberta, Edmonton, AB, Canada
| | - Olga Winkler
- Department of Psychiatry, University of Alberta, Edmonton, AB, Canada
| | - Fernanda Talarico
- Department of Psychiatry, University of Alberta, Edmonton, AB, Canada
| | | | | | - Yanbo Zhang
- Department of Psychiatry, University of Alberta, Edmonton, AB, Canada
| | - Eric Vermetten
- Department of Psychiatry, Leiden University Medical Center, Leiden, The Netherlands
| | - Lisa Burback
- Department of Psychiatry, University of Alberta, Edmonton, AB, Canada,Lisa Burback, Department of Psychiatry, University of Alberta, Edmonton, AB T6G 2R7, Canada.
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Modesti MN, Rapisarda L, Capriotti G, Del Casale A. Functional Neuroimaging in Dissociative Disorders: A Systematic Review. J Pers Med 2022; 12:jpm12091405. [PMID: 36143190 PMCID: PMC9502311 DOI: 10.3390/jpm12091405] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2022] [Revised: 08/21/2022] [Accepted: 08/26/2022] [Indexed: 11/16/2022] Open
Abstract
Background: Dissociative disorders encompass loss of integration in essential functions such as memory, consciousness, perception, motor control, and identity. Nevertheless, neuroimaging studies, albeit scarce, have suggested the existence of particular brain activation patterns in patients belonging to this diagnostic category. The aim of this review is to identify the main functional neuroimaging correlates of dissociative disorders. Methods: we searched the PubMed database to identify functional neuroimaging studies conducted on subjects with a diagnosis of a dissociative disorder, following the PRISMA guidelines. In the end, we included 13 studies in this systematic review, conducted on 51 patients with dissociative identity disorder (DID), 28 subjects affected by depersonalization disorder, 24 with dissociative amnesia, and 6 with other or not specified dissociative disorders. Results: Prefrontal cortex dysfunction seems prominent. In addition, changes in the functional neural network of the caudate are related to alterations of identity state and maintenance of an altered mental status in DID. Another role in DID seems to be played by a dysfunction of the anterior cingulate gyrus. Other regions, including parietal, temporal, and insular cortices, and subcortical areas were reported to be dysfunctional in dissociative disorders. Conclusions: Prefrontal dysfunction is frequently reported in dissociative disorders. Functional changes in other cortical and subcortical areas can be correlated with these diagnoses. Further studies are needed to clarify the neurofunctional correlations of each dissociative disorder in affected patients, in order to identify better tailored treatments.
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Affiliation(s)
- Martina Nicole Modesti
- Faculty of Medicine and Psychology, Sapienza University of Rome, Via di Grottarossa 1035, 00189 Rome, Italy
| | - Ludovica Rapisarda
- Faculty of Medicine and Psychology, Sapienza University of Rome, Via di Grottarossa 1035, 00189 Rome, Italy
| | - Gabriela Capriotti
- Unit of Nuclear Medicine, Department of Medical-Surgical Sciences and Translational Medicine, Faculty of Medicine and Psychology, Sant’Andrea University Hospital, Sapienza University of Rome, Via di Grottarossa 1035, 00189 Rome, Italy
| | - Antonio Del Casale
- Unit of Psychiatry, Department of Dynamic and Clinical Psychology, Faculty of Medicine and Psychology, Sant’Andrea University Hospital, Sapienza University of Rome, Via di Grottarossa 1035, 00189 Rome, Italy
- Correspondence:
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Vissia EM, Lawrence AJ, Chalavi S, Giesen ME, Draijer N, Nijenhuis ERS, Aleman A, Veltman DJ, Reinders AATS. Dissociative identity state-dependent working memory in dissociative identity disorder: a controlled functional magnetic resonance imaging study. BJPsych Open 2022; 8:e82. [PMID: 35403592 PMCID: PMC9059616 DOI: 10.1192/bjo.2022.22] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/22/2023] Open
Abstract
BACKGROUND Memory function is at the core of the psychopathology of dissociative identity disorder (DID), but little is known about its psychobiological correlates. AIMS This study aims to investigate whether memory function in DID differs between dissociative identity states. METHOD Behavioural data and neural activation patterns were assessed in 92 sessions during an n-back working memory task. Participants were people with genuine diagnosed DID (n = 14), DID-simulating controls (n = 16) and a paired control group (post-traumatic stress disorder (n = 16), healthy controls (n = 16)). Both DID groups participated as authentic or simulated neutral and trauma-related identity states. Reaction times and errors of omission were analysed with repeated measures ANOVA. Working memory neural activation (main working memory and linear load) was investigated for effects of identity state, participant group and their interaction. RESULTS Identity state-dependent behavioural performance and neural activation was found. DID simulators made fewer errors of omission than those with genuine DID. Regarding the prefrontal parietal network, main working memory in the left frontal pole and ventrolateral prefrontal cortex (Brodmann area 44) was activated in all three simulated neutral states, and in trauma-related identity states of DID simulators, but not those with genuine DID or post-traumatic stress disorder; for linear load, trauma-related identity states of those with genuine DID did not engage the parietal regions. CONCLUSIONS Behavioural performance and neural activation patterns related to working memory in DID are dependent on the dissociative identities involved. The narrowed consciousness of trauma-related identity states, with a proneness to re-experiencing traumatising events, may relate to poorer working memory functioning.
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Affiliation(s)
- Eline M Vissia
- Cognitive Neuroscience Centre, University Medical Centre Groningen, University of Groningen, The Netherlands; and Centre for Psychotrauma, Heelzorg, The Netherlands
| | - Andrew J Lawrence
- Department of Psychological Medicine, Institute of Psychiatry, Psychology & Neuroscience, King's College London, UK
| | - Sima Chalavi
- Cognitive Neuroscience Centre, University Medical Centre Groningen, University of Groningen, The Netherlands; and Research Centre for Movement Control and Neuroplasticity, Department of Movement Sciences, Katholieke Universiteit Leuven, Belgium
| | - Mechteld E Giesen
- Cognitive Neuroscience Centre, University Medical Centre Groningen, University of Groningen, The Netherlands
| | - Nel Draijer
- Department of Psychiatry, VU University Medical Center, Amsterdam University Medical Center, The Netherlands
| | | | - André Aleman
- Cognitive Neuroscience Centre, University Medical Centre Groningen, University of Groningen, The Netherlands
| | - Dick J Veltman
- Department of Psychiatry, VU University Medical Center, Amsterdam University Medical Center, The Netherlands
| | - Antje A T S Reinders
- Cognitive Neuroscience Centre, University Medical Centre Groningen, University of Groningen, The Netherlands; and Department of Psychological Medicine, Institute of Psychiatry, Psychology & Neuroscience, King's College London, UK
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Schlumpf YR, Nijenhuis ERS, Klein C, Jäncke L, Bachmann S. Functional connectivity changes in the delta frequency band following trauma treatment in complex trauma and dissociative disorder patients. Front Psychiatry 2022; 13:889560. [PMID: 35966482 PMCID: PMC9364934 DOI: 10.3389/fpsyt.2022.889560] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/04/2022] [Accepted: 06/27/2022] [Indexed: 11/13/2022] Open
Abstract
OBJECTIVE Phase-oriented trauma treatment is efficacious in the treatment of complex trauma and dissociative disorder patients. However, the neural correlates of this therapeutic effect are not yet well-understood. In the current study we investigated whether patients show a strengthening in functional network connectivity in the delta frequency band (1-3.5 Hz) over the course of phase-oriented inpatient trauma treatment while they performed an emotion regulation task. Further, we examined whether neural changes were associated with symptom reduction and improvement in emotion regulation skills. METHODS Before and after 8 weeks of treatment, electroencephalography (EEG) was acquired in patients (n = 28) with a complex posttraumatic stress disorder (cPTSD) or complex dissociative disorder (CDD). They also completed clinical and emotion regulation questionnaires. To delimit data variability, patients participated as one dissociative part that is referred to as Apparently Normal Part (ANP). Patients' data were compared to a matched healthy control croup (n = 38), also measured twice. RESULTS Prior to treatment, functional connectivity was significantly lower in patients compared to controls during cognitive reappraisal of unpleasant pictures and passive viewing of unpleasant and neutral pictures. These hypoconnected networks largely overlapped with networks typically activated during the recall of (emotional) autobiographical memories. Functional connectivity strength within these networks significantly increased following treatment and was comparable to controls. Patients showed symptom reduction across various clinical domains and improvement in the use of cognitive reappraisal as emotion regulation strategy. Treatment-related network normalizations were not related to changes in questionnaire data. CONCLUSION Phase-oriented treatment may strengthen connections between regions that are activated during autobiographical recall. These findings encourage further investigation of this circuitry as a therapeutic target in cPTSD and CDD patients. CLINIAL TRIAL REGISTRATION www.ClinicalTrials.gov, identifier: NCT02459340, https://www.kofam.ch/de/studienportal/suche/149284/studie/26681.
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Affiliation(s)
- Yolanda R Schlumpf
- Division of Neuropsychology, Department of Psychology, University of Zurich, Zurich, Switzerland.,Clienia Littenheid AG, Hospital for Psychiatry and Psychotherapy, Littenheid, Switzerland
| | - Ellert R S Nijenhuis
- Clienia Littenheid AG, Hospital for Psychiatry and Psychotherapy, Littenheid, Switzerland
| | - Carina Klein
- Division of Neuropsychology, Department of Psychology, University of Zurich, Zurich, Switzerland
| | - Lutz Jäncke
- Division of Neuropsychology, Department of Psychology, University of Zurich, Zurich, Switzerland.,Research Unit for Plasticity and Learning of the Healthy Aging Brain, University of Zurich, Zurich, Switzerland
| | - Silke Bachmann
- Clienia Littenheid AG, Hospital for Psychiatry and Psychotherapy, Littenheid, Switzerland.,Department of Psychiatry, Psychotherapy, and Psychosomatics, University Hospitals and University of Halle (Saale), Halle, Germany.,Department of Psychiatry, University Hospitals of Geneva, Geneva, Switzerland
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Schlumpf YR, Nijenhuis ERS, Klein C, Jäncke L, Bachmann S. Resting-state functional connectivity in patients with a complex PTSD or complex dissociative disorder before and after inpatient trauma treatment. Brain Behav 2021; 11:e02200. [PMID: 34105902 PMCID: PMC8323038 DOI: 10.1002/brb3.2200] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/26/2020] [Revised: 04/30/2021] [Accepted: 05/09/2021] [Indexed: 01/09/2023] Open
Abstract
INTRODUCTION Recent research suggests that traumatized patients are characterized by disrupted resting-state functional connectivity. We examined whether neural networks involved in resting-state change over the course of a phase-oriented inpatient treatment for complex traumatized and dissociative disorder patients. We also investigated associations between these network alterations and clinical symptoms and emotion regulation skills. METHODS Pre- and post-treatment, electroencephalography (EEG) was recorded during resting-state in patients (n = 23) with a complex dissociative disorder (CDD) or complex posttraumatic stress disorder (cPTSD). Patients also completed clinical and emotion regulation questionnaires. To reduce variance in the collected data, patients were exclusively tested as one prototypical dissociative part referred to as Apparently Normal Part (ANP). Functional network connectivity was examined and compared with a matched healthy control group (n = 37), also measured twice. RESULTS Prior to treatment and compared with controls, patients had a significantly lower functional connectivity strength within eyes-open and eyes-closed resting-state networks in the theta and alpha frequency band. Following treatment, functional connectivity strength within these networks was comparable to the control group and comprised areas belonging to the default mode network (DMN) and prefrontal as well as anterior cingulate control regions. Treatment-related network normalizations in the theta frequency band were associated with a self-reported increase in the use of cognitive reappraisal strategies and reduction in emotion regulation difficulties. CONCLUSION Phase-oriented trauma treatment can strengthen resting-state network connectivity and can increase the capacity of complex traumatized and dissociative patients as ANP to handle emotional challenges effectively.
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Affiliation(s)
- Yolanda R. Schlumpf
- Division of Neuropsychology, Department of PsychologyUniversity of ZurichZurichSwitzerland
- Clienia Littenheid AGHospital for Psychiatry and PsychotherapyLittenheidSwitzerland
| | | | - Carina Klein
- Division of Neuropsychology, Department of PsychologyUniversity of ZurichZurichSwitzerland
| | - Lutz Jäncke
- Division of Neuropsychology, Department of PsychologyUniversity of ZurichZurichSwitzerland
- Research Unit for Plasticity and Learning of the Healthy Aging BrainUniversity of ZurichZurichSwitzerland
| | - Silke Bachmann
- Department of Psychiatry, Psychotherapy, and PsychosomaticsUniversity Hospitals and University of Halle (Saale)HalleGermany
- Department of PsychiatryUniversity Hospitals of GenevaGenevaSwitzerland
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Krause-Utz A, Frost R, Chatzaki E, Winter D, Schmahl C, Elzinga BM. Dissociation in Borderline Personality Disorder: Recent Experimental, Neurobiological Studies, and Implications for Future Research and Treatment. Curr Psychiatry Rep 2021; 23:37. [PMID: 33909198 PMCID: PMC8081699 DOI: 10.1007/s11920-021-01246-8] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 03/24/2021] [Indexed: 02/06/2023]
Abstract
PURPOSE OF REVIEW The aim of this review article is to give an overview over recent experimental neurobiological research on dissociation in borderline personality disorder (BPD), in order to inform clinicians and to stimulate further research. First, we introduce basic definitions and models that conceptualize dissociation from a transdiagnostic perspective. Then, we discuss recent findings in BPD. RECENT FINDINGS Stress-related dissociation is a key symptom of BPD, closely linked to other core domains of the disorder (emotion dysregulation, identity disturbances, and interpersonal disturbances). The understanding of neurobiological correlates of dissociation across different psychiatric disorders (e.g., dissociative disorders, post-traumatic stress disorder) is steadily increasing. At the same time, studies explicitly focusing on dissociation in BPD are still scarce. There is evidence for adverse effects of dissociation on affective-cognitive functioning (e.g., interference inhibition), body perception, and psychotherapeutic treatment response in BPD. On the neural level, increased activity in frontal regions (e.g., inferior frontal gyrus) and temporal areas (e.g., inferior and superior temporal gyrus) during symptom provocation tasks and during resting state was observed, although findings are still diverse and need to be replicated. Conceptual differences and methodological differences in study designs and sample characteristics (e.g., comorbidities, trauma history) hinder a straightforward interpretation and comparison of studies. Given the potentially detrimental impact of dissociation in BPD, more research on the topic is strongly needed to deepen the understanding of this complex clinical condition.
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Affiliation(s)
- Annegret Krause-Utz
- Institute of Clinical Psychology, Leiden University, Leiden, The Netherlands.
- Leiden Institute for Brain and Cognition (LIBC), Leiden, The Netherlands.
| | - Rachel Frost
- Department of Psychology, King's College London, Institute of Psychiatry Psychology & Neuroscience, London, UK
| | - Elianne Chatzaki
- Institute of Clinical Psychology, Leiden University, Leiden, The Netherlands
| | - Dorina Winter
- Pain and Psychotherapy Research Lab, University of Koblenz-Landau, Landau, Germany
| | - Christian Schmahl
- Department of Psychosomatic Medicine and Psychotherapy, Central Institute of Mental Health Mannheim, Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany
| | - Bernet M Elzinga
- Institute of Clinical Psychology, Leiden University, Leiden, The Netherlands
- Leiden Institute for Brain and Cognition (LIBC), Leiden, The Netherlands
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Roydeva MI, Reinders AATS. Biomarkers of Pathological Dissociation: A Systematic Review. Neurosci Biobehav Rev 2020; 123:120-202. [PMID: 33271160 DOI: 10.1016/j.neubiorev.2020.11.019] [Citation(s) in RCA: 46] [Impact Index Per Article: 11.5] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2020] [Revised: 08/20/2020] [Accepted: 11/15/2020] [Indexed: 02/06/2023]
Abstract
Pathological dissociation is a severe, debilitating and transdiagnostic psychiatric symptom. This review identifies biomarkers of pathological dissociation in a transdiagnostic manner to recommend the most promising research and treatment pathways in support of the precision medicine framework. A total of 205 unique studies that met inclusion criteria were included. Studies were divided into four biomarker categories, namely neuroimaging, psychobiological, psychophysiological and genetic biomarkers. The dorsomedial and dorsolateral prefrontal cortex, bilateral superior frontal regions, (anterior) cingulate, posterior association areas and basal ganglia are identified as neurofunctional biomarkers of pathological dissociation and decreased hippocampal, basal ganglia and thalamic volumes as neurostructural biomarkers. Increased oxytocin and prolactin and decreased tumor necrosis factor alpha (TNF-α) are identified as psychobiological markers. Psychophysiological biomarkers, including blood pressure, heart rate and skin conductance, were inconclusive. For the genetic biomarker category studies related to dissociation were limited and no clear directionality of effect was found to warrant identification of a genetic biomarker. Recommendations for future research pathways and possible clinical applicability are provided.
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Affiliation(s)
- Monika I Roydeva
- Department of Psychosis Studies, Institute of Psychiatry, Psychology and Neuroscience, King's College London, United Kingdom
| | - Antje A T S Reinders
- Department of Psychological Medicine, Institute of Psychiatry, Psychology & Neuroscience, King's College London, United Kingdom.
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16
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Piedfort-Marin O. Psychotherapy of postpartum dissociative psychosis based on the theory of the structural dissociation of the personality and hypnotherapy: A case study. EUROPEAN JOURNAL OF TRAUMA & DISSOCIATION 2020. [DOI: 10.1016/j.ejtd.2019.100129] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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17
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Scalabrini A, Mucci C, Esposito R, Damiani S, Northoff G. Dissociation as a disorder of integration - On the footsteps of Pierre Janet. Prog Neuropsychopharmacol Biol Psychiatry 2020; 101:109928. [PMID: 32194203 DOI: 10.1016/j.pnpbp.2020.109928] [Citation(s) in RCA: 35] [Impact Index Per Article: 8.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/01/2019] [Revised: 02/13/2020] [Accepted: 03/12/2020] [Indexed: 12/19/2022]
Abstract
At the end of the 19th century Pierre Janet described dissociation as an altered state of consciousness manifested in disrupted integration of psychological functions. Clinically, such disruption comprises compartmentalization symptoms like amnesia, detachment symptoms like depersonalization/derealization, and structural dissociation of personality with changes in the sense of self. The exact neuronal mechanisms leading to these different symptoms remain unclear. We here suggest to put Janet's original account of dissociation as disrupted integration of psychological functions into a novel context, that is, a neuronal context as related to current brain imaging. This requires a combined theoretical and empirical approach on data supporting such neuronal reframing of Janet. For that, we here review (i) past and (ii) recent psychological and neuronal views on dissociation together with neuroscientific theories of integration, which (iii) are supported and complemented by preliminary fMRI data. We propose three neuronal mechanisms of dynamic integration operating at different levels of the brain's spontaneous activity - temporo-spatial binding on the regional level, temporo-spatial synchronization on the network level, and temporo-spatial globalization on the global level. These neuronal mechanisms, in turn, may be related to different symptomatic manifestation of dissociation operating at different levels, e.g., compartmentalization, detachment, and structural, which, as we suggest, can all be traced to disrupted integration of neuronal and psychological functions as originally envisioned by Janet.
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Affiliation(s)
- Andrea Scalabrini
- Department of Psychological, Health and Territorial Sciences (DiSPuTer), G. d'Annunzio University of Chieti-Pescara, Via dei Vestini 33, Chieti (CH) 66100, Italy.
| | - Clara Mucci
- Department of Psychological, Health and Territorial Sciences (DiSPuTer), G. d'Annunzio University of Chieti-Pescara, Via dei Vestini 33, Chieti (CH) 66100, Italy
| | - Rosy Esposito
- Department of Psychological, Health and Territorial Sciences (DiSPuTer), G. d'Annunzio University of Chieti-Pescara, Via dei Vestini 33, Chieti (CH) 66100, Italy
| | - Stefano Damiani
- Department of Brain and Behavioral Science, University of Pavia, Pavia 27100, Italy
| | - Georg Northoff
- The Royal's Institute of Mental Health Research, University of Ottawa, Canada; Brain and Mind Research Institute, Centre for Neural Dynamics, Faculty of Medicine, University of Ottawa, 145 Carling Avenue, Rm. 6435, Ottawa, Ontario K1Z 7K4, Canada; Mental Health Centre, Zhejiang University School of Medicine, Tianmu Road 305, Zhejiang Province, Hangzhou 310013, China; Centre for Cognition and Brain Disorders, Hangzhou Normal University, Tianmu Road 305, Zhejiang Province, Hangzhou 310013, China; TMU Research Centre for Brain and Consciousness, Shuang Hospital, Taipei MedicalUniversity, No. 250 Wu-Xing Street, 11031 Taipei, Taiwan; Graduate Institute of Humanities in Medicine, Taipei Medical University, No. 250 Wu-Xing Street, Taipei 11031, Taiwan.
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18
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Smith GP, Hartelius G. Resolution of Dissociated Ego States Relieves Flashback-Related Symptoms in Combat-Related PTSD: A Brief Mindfulness Based Intervention. MILITARY PSYCHOLOGY 2020; 32:135-148. [PMID: 38536266 PMCID: PMC10013259 DOI: 10.1080/08995605.2019.1654292] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2018] [Accepted: 08/07/2019] [Indexed: 10/25/2022]
Abstract
A novel understanding and therapeutic approach to the treatment of PTSD-related flashback triggers are described. Triggered responses are conceptualized as the result of latent dissociative structures of neural organization and psychodynamic functioning activated by current events. The dissociative structure - here described as a dissociated ego state (DES) - reflects a fracturing of executive functioning resulting in a delimited aspect of self that is not under cognitive control or subject to cognitive inhibition by the self of daily experience, and is the psychological construct behind intrusive PTSD symptoms. Use of a mindful attentional state permits regulated access to the DES (therapeutic engagement without risk of emotional dysregulation) so that dissociated cognitive resources can be recovered and the dissociated structure deactivated. This may relieve maladaptive responses and behaviors associated with the DES in a profound and durable way, without the need for exposure to or recovery of traumatic memories. Based on this understanding, a 9-step intervention is introduced with a case example of a Vietnam veteran suffering PTSD symptoms for 49 years with significant gains maintained at 21 months follow up. These findings demonstrate rapid and durable resolution of chronic PTSD symptoms through a mindfulness-based approach that focused on deactivation of dissociated ego states, in contrast to targeting trauma memories. If proven efficacious, this novel approach may result in reduced treatment costs and improved outcomes for veterans suffering with PTSD.
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Affiliation(s)
- Genine P. Smith
- Department of Integral and Transpersonal Psychology, California Institute of Integral Studies, San Francisco, California, USA
| | - Glenn Hartelius
- Department of Integral and Transpersonal Psychology, California Institute of Integral Studies, San Francisco, California, USA
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19
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La théorie de la dissociation structurelle de la personnalité pour conceptualiser et traiter la psychose dissociative : deux études de cas. ANNALES MEDICO-PSYCHOLOGIQUES 2019. [DOI: 10.1016/j.amp.2018.04.013] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
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20
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Kinley JL, Reyno SM. The Price of Needing to Belong: Neurobiology of Working Through Attachment Trauma. Psychodyn Psychiatry 2019; 47:39-51. [PMID: 30840555 DOI: 10.1521/pdps.2019.47.1.39] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
Belonging is fundamental to health and well-being. Complex relational trauma disrupts attachments, negatively impacting developing neurobiology and has significant implications for attachment behaviors, mental health, and treatment planning. We have developed a dynamic relational (DR) model of psychotherapy that aims to restore a healthy sense of belonging, targeting levels of activation and integration of large scale neural networks in the service of increasing the emotional capacities (attunement, processing, regulation, and expression) required to work through attachment trauma and establish healthy relationships. Our DR model provides an organizing framework through which to understand both the phenomenology observed in complex trauma and the mechanisms of therapeutic change. Our approach informs the weighting and timing of interventions to actively address capacity deficits, ego-syntonic symptoms, and unconscious resistance. The implications of this model also relate to the pathogenesis of mental disorder, and suggest prevention and early intervention efforts focus on modulation of subcortical (autonomic) responses and the encouragement of balanced cortical integration to enhance cognitive flexibility/psychological resilience. Ultimately, interventions based on our systematic model may modulate the genetic diathesis and comorbidities of relational trauma and increase psychological resilience.
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Affiliation(s)
- Jacqueline L Kinley
- Queen Elizabeth II Health Sciences Centre, and Department of Psychiatry, Dalhousie University, Halifax, Nova Scotia
| | - Sandra M Reyno
- Queen Elizabeth II Health Sciences Centre, Halifax, Nova Scotia
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21
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Schlumpf YR, Nijenhuis ERS, Klein C, Jäncke L, Bachmann S. Functional reorganization of neural networks involved in emotion regulation following trauma therapy for complex trauma disorders. Neuroimage Clin 2019; 23:101807. [PMID: 30986752 PMCID: PMC6505069 DOI: 10.1016/j.nicl.2019.101807] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2018] [Revised: 03/13/2019] [Accepted: 03/30/2019] [Indexed: 12/14/2022]
Abstract
OBJECTIVES We investigated whether patients with complex interpersonal trauma engage neural networks that are commonly activated during cognitive reappraisal and responding naturally to affect-laden images. In this naturalistic study, we examined whether trauma treatment not only reduces symptoms but also changes neural networks involved in emotional control. METHODS Before and after eight weeks of phase-oriented inpatient trauma treatment, patients (n = 28) with complex posttraumatic stress disorder (cPTSD) and complex dissociative disorders (CDD) performed a cognitive reappraisal task while electroencephalography (EEG) was registered. Patients were measured as a prototypical dissociative part that aims to fulfill daily life goals while avoiding traumatic memories and associated dissociative parts. Matched healthy controls (n = 38) were measured twice as well. We examined task-related functional connectivity and assessed self-reports of clinical symptoms and emotion regulation skills. RESULTS Prior to treatment and compared to controls, patients showed hypoconnectivity within neural networks involved in emotional downregulation while reappraising affect-eliciting pictures as well as viewing neutral and affect-eliciting pictures. Following treatment, connectivity became normalized in these networks comprising regions associated with cognitive control and memory. Additionally, patients showed a treatment-related reduction of negative but not of positive dissociative symptoms. CONCLUSIONS This is the first study demonstrating that trauma-focused treatment was associated with favorable changes in neural networks involved in emotional control. Emotional overregulation manifesting as negative dissociative symptoms was reduced but not emotional underregulation, manifesting as positive dissociative symptoms.
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Affiliation(s)
- Yolanda R Schlumpf
- Division of Neuropsychology, Institute of Psychology, University of Zurich, Switzerland; Clienia Littenheid AG, Hospital for Psychiatry and Psychotherapy, Littenheid, Switzerland.
| | - Ellert R S Nijenhuis
- Clienia Littenheid AG, Hospital for Psychiatry and Psychotherapy, Littenheid, Switzerland
| | - Carina Klein
- Division of Neuropsychology, Institute of Psychology, University of Zurich, Switzerland
| | - Lutz Jäncke
- Division of Neuropsychology, Institute of Psychology, University of Zurich, Switzerland; Research Unit for Plasticity and Learning of the Healthy Aging Brain, University of Zurich, Switzerland
| | - Silke Bachmann
- Clienia Littenheid AG, Hospital for Psychiatry and Psychotherapy, Littenheid, Switzerland; Department of Psychiatry, Psychotherapy, and Psychosomatics, University Hospitals and University of Halle (Saale), Halle, Germany
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22
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Chefetz RA. Psycho-Neurobiology and Its Potential Influence on Psychotherapy: Being, Doing, and the Risk of Scientism. Psychodyn Psychiatry 2019; 47:53-80. [PMID: 30840558 DOI: 10.1521/pdps.2019.47.1.53] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
Neuroscientific information may transform the modern practice of psychotherapy. Still we must pay heed to the most salient of the common factors generating therapeutic change: the relationship between patient and therapist. Likewise, brain and body are both part of mind and we ignore this at our clinical peril. Research on affective, cognitive, mnemic, somatic, psychophysiologic, developmental, and integrative mental processes, amongst others, must hold to a high standard of translation from basic scientific findings or we risk practicing a psychotherapy enslaved to an authoritarian scientism as a substitute for the creation of unfettered intimacy and engagement. A balanced approach is required if in trauma treatment, for example, we are to be both potential beneficiaries of understanding what is in our human heads while not losing track of our very human hearts. Each clinician need develop a basic knowledge of neuroscience in order to critically assess the meanings of new findings and their proper place in the practice of all the psychotherapies.
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Affiliation(s)
- Richard A Chefetz
- Psychiatrist in private practice in Washington, D.C. He was President of the International Society for the Study of Trauma and Dissociation (2002-2003), and is a Distinguished Visiting Lecturer at the William Alanson White Institute of Psychiatry, Psychoanalysis, and Psychology. He is a faculty member at the Washington School of Psychiatry, the Institute of Contemporary Psychotherapy & Psychoanalysis, and the Washington-Baltimore Center for Psychoanalysis
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23
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Lebois LAM, Wolff JD, Hill SB, Bigony CE, Winternitz S, Ressler KJ, Kaufman ML. Preliminary Evidence of a Missing Self Bias in Face Perception for Individuals with Dissociative Identity Disorder. J Trauma Dissociation 2019; 20:140-164. [PMID: 30445887 PMCID: PMC6397096 DOI: 10.1080/15299732.2018.1547807] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/29/2023]
Abstract
Failing to recognize one's mirror image can signal an abnormality in one's sense of self. In dissociative identity disorder (DID), individuals often report that their mirror image can feel unfamiliar or distorted. They also experience some of their own thoughts, emotions, and bodily sensations as if they are nonautobiographical and sometimes as if instead, they belong to someone else. To assess these experiences, we designed a novel backwards masking paradigm in which participants were covertly shown their own face, masked by a stranger's face. Participants rated feelings of familiarity associated with the strangers' faces. 21 control participants without trauma-generated dissociation rated masks, which were covertly preceded by their own face, as more familiar compared to masks preceded by a stranger's face. In contrast, across two samples, 28 individuals with DID and similar clinical presentations (DSM-IV Dissociative Disorder Not Otherwise Specified type 1) did not show increased familiarity ratings to their own masked face. However, their familiarity ratings interacted with self-reported identity state integration. Individuals with higher levels of identity state integration had response patterns similar to control participants. These data provide empirical evidence of aberrant self-referential processing in DID/DDNOS and suggest this is restored with identity state integration.
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Affiliation(s)
- Lauren A M Lebois
- a Division of Depression and Anxiety Disorders , McLean Hospital , Belmont , MA , USA.,b Division of Women's Mental Health , Harvard Medical School , Belmont , MA , USA
| | - Jonathan D Wolff
- a Division of Depression and Anxiety Disorders , McLean Hospital , Belmont , MA , USA
| | - Sarah B Hill
- a Division of Depression and Anxiety Disorders , McLean Hospital , Belmont , MA , USA
| | - Cara E Bigony
- a Division of Depression and Anxiety Disorders , McLean Hospital , Belmont , MA , USA.,c Graduate School of Education , Fordham University , New York , NY , USA
| | - Sherry Winternitz
- a Division of Depression and Anxiety Disorders , McLean Hospital , Belmont , MA , USA.,b Division of Women's Mental Health , Harvard Medical School , Belmont , MA , USA
| | - Kerry J Ressler
- a Division of Depression and Anxiety Disorders , McLean Hospital , Belmont , MA , USA.,b Division of Women's Mental Health , Harvard Medical School , Belmont , MA , USA
| | - Milissa L Kaufman
- a Division of Depression and Anxiety Disorders , McLean Hospital , Belmont , MA , USA.,b Division of Women's Mental Health , Harvard Medical School , Belmont , MA , USA
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Abstract
Mindfulness based psychotherapeutic interventions have shown to be an effective intervention for quite some time now. These intervention, however, have not been that successful with individuals who experience dissociative disorders. There is a very clear disconnect between these two fields. In an attempt to close the gap, reviewing what mindfulness might be from an attachment and human developed lens, one can learn that there is a lot more occurring in a mindful state other than relaxation. There is a level of human development achievement that comes from a regular mindfulness practice that seems to play a role in raising our young and being part of a complex social group. Evidence suggests that the end product of mindfulness is likely deeply connected human relationships and balanced care-giving abilities. In knowing the benefits from a relational perspective of mindfulness those in the dissociative world can utilize adaptations of mindfulness so that their clients can eventually learn to developed mindfulness and, in turn, have the same deeply connected relationship that they often missed. Conversely those in the mindfulness based therapeutic world can learn a lot about dissociation and harmed people by understanding the real difficulties that individuals with dissociative disorders have in experiencing a mindful state. They can learn to understand the need to adapt mindfulness based practices to accommodate individuals who have a system that is phobic of awareness, terrified of being calm and who have no concept of what non-judgement means. Both fields would benefit greatly by knowing more about the other.
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25
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Temple MJ. Understanding, identifying and managing severe dissociative disorders in general psychiatric settings. BJPSYCH ADVANCES 2019. [DOI: 10.1192/bja.2018.54] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/27/2023]
Abstract
SUMMARYThe severe dissociative disorders of dissociative identity disorder (DID) and dissociative disorder not otherwise specified (DDNOS) are complex, not uncommon presentations associated with severe symptoms, high rates of comorbidity, high service use compared with other psychiatric disorders, and high suicidality. They exact high personal and socioeconomic burdens and show poor response to standard treatments, with high levels of treatment attrition and ‘revolving-door’ out-patient and in-patient service use; patients are often misdiagnosed or labelled ‘untreatable’. DID and DDNOS diagnoses remain controversial, but they have been repeatedly validated internationally over the past 20 years and the disorders can be accurately identified using screening tools and structured clinical interviews. Neurobiological understanding of the disorders is increasing; findings are consistent with a trauma origin and have commonality with features seen in other trauma-related disorders. Specialist treatment that addresses the dissociative symptoms alongside their trauma origins shows promise in early evidence. Working knowledge of these disorders among non-specialist psychiatrists and psychologists in the UK remains poor, resulting in long delays before diagnosis and treatment.LEARNING OBJECTIVES•Understand trauma-related DID and DDNOS, in particular that they are ‘real’ and not rare disorders•Know when to suspect their presence in general psychiatric settings and how to assess for them•Understand (and help the patient to access) specialist treatments and be able to apply general approaches in the non-specialist settingDECLARATION OF INTERESTNone.
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26
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Stevanovic D, Brajkovic L, Srivastava MK, Krgovic I, Jancic J. Widespread cortical PET abnormalities in an adolescent related to a PNES dissociative state, PTSD, ADHD, and domestic violence exposure. Scand J Child Adolesc Psychiatr Psychol 2018; 6:98-106. [PMID: 33520757 PMCID: PMC7703842 DOI: 10.21307/sjcapp-2018-011] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023] Open
Abstract
Background Accumulated evidence indicates that exposure to trauma is associated with the development of cognitive impairments and psychiatric symptoms in children and adolescents. Objective In this case study of a female adolescent of 17 years, we aimed to evaluate how cortical positron emission tomography (PET) abnormalities relate to psychogenic non-epileptic seizure (PNES) dissociative state, post-traumatic stress disorder (PTSD), attention-deficit/hyperactivity disorder (ADHD), and domestic violence exposure. Methods Detailed psychiatric and neuropsychological assessment was performed initially, followed by a PET study. The PET imaging was carried out in the resting-state and in the dissociative-state. Results The adolescent was suffering from multiple episodes of unconsciousness, all found to be psychogenic; thus, PNES was diagnosed. However, at the psychopathology symptom level, the adolescent had heightened impulsivity, hyperactivity, hyperarousal, anxiety, somatic, and dissociative/ functional neurological symptoms present separately or concurrently at some point during her life; thus, the criteria for PTSD and ADHD were also fulfilled. In the resting state, significant hypometabolism was observed in the occipital, occipitotemporal, polar, and mesial parts of the temporal regions bilaterally, fronto-parietal medial and lateral pericental regions, and fronto-temporal and insular region on the left. The most intense metabolism was observed in the posterior cingulate gyrus and the medial parts of the posterior parietal lobe. In the dissociative state, there was a slight increase in the metabolism of the brain globally compared with the resting state, but with identical distribution of the regional changes observed. Conclusions Widespread cortical PET abnormalities were found, possibly indicating alterations in large-scale brain networks, in a patient with PNES and a dissociative state, PTSD, and ADHD, who was exposed to chronic domestic violence.
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Affiliation(s)
- Dejan Stevanovic
- Clinic of Neurology and Psychiatry for Children and Youth, Belgrade, Serbia
| | - Leposava Brajkovic
- University of Belgrade Center for Nuclear Medicine, Clinical Center of Serbia, Belgrade, Serbia
| | | | - Ivan Krgovic
- Clinic of Neurology and Psychiatry for Children and Youth, Belgrade, Serbia
| | - Jasna Jancic
- Clinic of Neurology and Psychiatry for Children and Youth, Belgrade, Serbia.,Faculty of Medicine, University of Belgrade, Belgrade, Serbia
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Fenster RJ, Lebois LAM, Ressler KJ, Suh J. Brain circuit dysfunction in post-traumatic stress disorder: from mouse to man. Nat Rev Neurosci 2018; 19:535-551. [PMID: 30054570 PMCID: PMC6148363 DOI: 10.1038/s41583-018-0039-7] [Citation(s) in RCA: 244] [Impact Index Per Article: 40.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
Abstract
Post-traumatic stress disorder (PTSD) is a prevalent, debilitating and sometimes deadly consequence of exposure to severe psychological trauma. Although effective treatments exist for some individuals, they are limited. New approaches to intervention, treatment and prevention are therefore much needed. In the past few years, the field has rapidly developed a greater understanding of the dysfunctional brain circuits underlying PTSD, a shift in understanding that has been made possible by technological revolutions that have allowed the observation and perturbation of the macrocircuits and microcircuits thought to underlie PTSD-related symptoms. These advances have allowed us to gain a more translational knowledge of PTSD, have provided further insights into the mechanisms of risk and resilience and offer promising avenues for therapeutic discovery.
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Affiliation(s)
- Robert J Fenster
- Division of Depression and Anxiety Disorders, McLean Hospital Department of Psychiatry, Harvard Medical School, Belmont, MA, USA
| | - Lauren A M Lebois
- Division of Depression and Anxiety Disorders, McLean Hospital Department of Psychiatry, Harvard Medical School, Belmont, MA, USA
| | - Kerry J Ressler
- Division of Depression and Anxiety Disorders, McLean Hospital Department of Psychiatry, Harvard Medical School, Belmont, MA, USA.
| | - Junghyup Suh
- Division of Depression and Anxiety Disorders, McLean Hospital Department of Psychiatry, Harvard Medical School, Belmont, MA, USA.
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28
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Schäflein E, Sattel HC, Pollatos O, Sack M. Disconnected - Impaired Interoceptive Accuracy and Its Association With Self-Perception and Cardiac Vagal Tone in Patients With Dissociative Disorder. Front Psychol 2018; 9:897. [PMID: 29997537 PMCID: PMC6031288 DOI: 10.3389/fpsyg.2018.00897] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2017] [Accepted: 05/17/2018] [Indexed: 11/13/2022] Open
Abstract
Patients suffering from dissociative disorders are characterized by an avoidance of aversive stimuli. This includes the avoidance of emotions and, in particular, bodily perceptions. In the present pilot study, we explored the potential interoceptive accuracy deficit of patients suffering from dissociative disorders in a heartbeat detection task. Moreover, we investigated the impact of facial mirror-confrontation on interoceptive accuracy and the potential association between cardiac vagal tone derived from heart rate variability and interoceptive accuracy. Eighteen patients suffering from dissociative disorders and 18 healthy controls were assessed with the Mental Tracking Paradigm by Schandry for heartbeat detection at baseline and after confrontations exposing them to their own faces in a mirror (2 min each, accompanied by a negative or positive cognition). During the experiment, cardiac vagal tone was assessed. We used Pearson correlations to calculate potential associations between cardiac vagal tone and interoceptive accuracy. Patients performed significantly worse than the healthy controls in the heartbeat detection task at baseline. They displayed no significant increase in interoceptive accuracy following facial mirror-confrontation. In the patient group, higher cardiac vagal tone was associated with a more precise heartbeat detection performance. Dissociative disorder patients showed a considerable deficit in interoceptive accuracy. Our results fit with the assumption that highly dissociative patients tend to tune out the perceiving of bodily signals. To the extent that bodily signal perception may play a causal role in these disorders, therapeutic approaches enhancing interoceptive accuracy and cardiac vagal tone may be considered important and practicable steps to improve the therapy outcome of this patient group.
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Affiliation(s)
- Eva Schäflein
- Department of Psychosomatic Medicine and Psychotherapy, Klinikum Rechts der Isar, Technical University of Munich, Munich, Germany
| | - Heribert C Sattel
- Department of Psychosomatic Medicine and Psychotherapy, Klinikum Rechts der Isar, Technical University of Munich, Munich, Germany
| | - Olga Pollatos
- Department of Clinical and Health Psychology, Institute of Psychology and Education, Ulm University, Ulm, Germany
| | - Martin Sack
- Department of Psychosomatic Medicine and Psychotherapy, Klinikum Rechts der Isar, Technical University of Munich, Munich, Germany
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29
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Gandotra K, Golish J, Rosenberg C, Strohl K. Dissociative Identity Disorder CPAP Adherence: An Uncommon Factor in Obstructive Sleep Apnea. J Clin Sleep Med 2018; 14:693-695. [PMID: 29609713 DOI: 10.5664/jcsm.7076] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2017] [Accepted: 11/30/2017] [Indexed: 11/13/2022]
Abstract
ABSTRACT We present a case of a patient with dissociative identity disorder and symptomatic sleep apnea who was treated with continuous positive airway pressure (CPAP). CPAP use depended upon which personality the patient exhibited but apnea reduction did not. This case illustrates in one individual how personality can positively or negatively affect CPAP adherence.
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Affiliation(s)
- Kamal Gandotra
- Division of Pulmonary and Sleep Medicine, Louis Stokes VA Medical Center, Cleveland, Ohio
| | - Joseph Golish
- Division of Pulmonary, Critical Care and Sleep Medicine, Metro Health Medical Center, Case Western Reserve University, Cleveland, Ohio
| | - Carl Rosenberg
- Division of Pulmonary and Sleep Medicine, Louis Stokes VA Medical Center, Cleveland, Ohio
| | - Kingman Strohl
- Division of Pulmonary and Sleep Medicine, Louis Stokes VA Medical Center, Cleveland, Ohio.,Division of Pulmonary, Critical Care and Sleep Medicine, University Hospitals Cleveland Medical Center, Case Western Reserve University, Cleveland, Ohio
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30
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Krause-Utz A, Elzinga B. Current Understanding of the Neural Mechanisms of Dissociation in Borderline Personality Disorder. Curr Behav Neurosci Rep 2018; 5:113-123. [PMID: 29577011 PMCID: PMC5857558 DOI: 10.1007/s40473-018-0146-9] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Purpose of Review In this article, we aim to give an overview over recent neuroimaging research on dissociation in borderline personality disorder (BPD). Stress-related dissociation is highly prevalent in BPD, while so far only little is known about its neural underpinnings. Recent Findings Based on research in depersonalization and the dissociative subtype of posttraumatic stress disorder, it has been proposed that dissociation involves alterations in a cortico-limbic network. In BPD, neuroimaging research explicitly focusing on dissociation is still scarce. Summary Functional neuroimaging studies have provided preliminary evidence for an altered recruitment and interplay of fronto-limbic regions (amygdala, anterior cingulate, inferior frontal gyrus, medial and dorsolateral prefrontal cortices) and temporoparietal areas (superior temporal gyrus, inferior parietal lobule, fusiform gyrus), which may underlie disrupted affective-cognitive processing during dissociation in BPD. More neuroimaging research with larger samples, clinical control groups, and repeated measurements is needed to deepen the understanding of dissociation in BPD.
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Affiliation(s)
- Annegret Krause-Utz
- Institute of Psychology, Leiden University, Leiden, The Netherlands
- Leiden Institute for Brain and Cognition (LIBC), Leiden, The Netherlands
| | - Bernet Elzinga
- Institute of Psychology, Leiden University, Leiden, The Netherlands
- Leiden Institute for Brain and Cognition (LIBC), Leiden, The Netherlands
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31
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Reinders AATS, Chalavi S, Schlumpf YR, Vissia EM, Nijenhuis ERS, Jäncke L, Veltman DJ, Ecker C. Neurodevelopmental origins of abnormal cortical morphology in dissociative identity disorder. Acta Psychiatr Scand 2018; 137:157-170. [PMID: 29282709 DOI: 10.1111/acps.12839] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 11/09/2017] [Indexed: 12/23/2022]
Abstract
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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Affiliation(s)
- A A T S Reinders
- Department of Psychological Medicine, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK.,Department of Neuroscience, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - S Chalavi
- Department of Neuroscience, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands.,Department of Biomedical Kinesiology, Research Center for Movement Control and Neuroplasticity, KU Leuven, Leuven, Belgium
| | - Y R Schlumpf
- Division of Neuropsychology, Institute of Psychology, University of Zurich, Zurich, Switzerland.,Private Clinic for Psychiatry and Psychotherapy, Clienia Littenheid AG, Littenheid, Switzerland
| | - E M Vissia
- Department of Neuroscience, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - E R S Nijenhuis
- Private Clinic for Psychiatry and Psychotherapy, Clienia Littenheid AG, Littenheid, Switzerland
| | - L Jäncke
- Division of Neuropsychology, Institute of Psychology, University of Zurich, Zurich, Switzerland.,Research Unit for Plasticity and Learning of the Healthy Aging Brain, University of Zurich, Zurich, Switzerland
| | - D J Veltman
- Department of Psychiatry, VU University Medical Center, Amsterdam, The Netherlands
| | - C Ecker
- Department of Child & Adolescent Psychiatry, Psychosomatics and Psychotherapy, University Hospital, Goethe University, Frankfurt am Main, Germany.,Department of Forensic and Neurodevelopmental Sciences, Institute of Psychiatry, Psychology and Neuroscience, King's College, London, UK
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32
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Del Río-Casanova L, González A, Páramo M, Van Dijke A, Brenlla J. Emotion regulation strategies in trauma-related disorders: pathways linking neurobiology and clinical manifestations. Rev Neurosci 2018; 27:385-95. [PMID: 26812780 DOI: 10.1515/revneuro-2015-0045] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2015] [Accepted: 11/29/2015] [Indexed: 01/30/2023]
Abstract
Emotion regulation impairments with traumatic origins have mainly been studied from posttraumatic stress disorder (PTSD) models by studying cases of adult onset and single-incident trauma exposure. The effects of adverse traumatic experiences, however, go beyond the PTSD. Different authors have proposed that PTSD, borderline personality, dissociative, conversive and somatoform disorders constitute a full spectrum of trauma-related conditions. Therefore, a comprehensive review of the neurobiological findings covering this posttraumatic spectrum is needed in order to develop an all-encompassing model for trauma-related disorders with emotion regulation at its center. The present review has sought to link neurobiology findings concerning cortico-limbic function to the field of emotion regulation. In so doing, trauma-related disorders have been placed in a continuum between under- and over-regulation of affect strategies. Under-regulation of affect was predominant in borderline personality disorder, PTSD with re-experiencing symptoms and positive psychoform and somatoform dissociative symptoms. Over-regulation of affect was more prevalent in somatoform disorders and pathologies characterized by negative psychoform and somatoform symptoms. Throughout this continuum, different combinations between under- and over-regulation of affect strategies were also found.
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33
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Schäflein E, Sattel H, Schmidt U, Sack M. The enemy in the mirror: self-perception-induced stress results in dissociation of psychological and physiological responses in patients with dissociative disorder. Eur J Psychotraumatol 2018; 9:1472991. [PMID: 29938011 PMCID: PMC6008582 DOI: 10.1080/20008198.2018.1472991] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/22/2017] [Accepted: 04/17/2018] [Indexed: 12/25/2022] Open
Abstract
Background: Patients suffering from dissociative disorders (DD) are characterized by an avoidance of aversive stimuli. Clinical experience has shown that DD patients typically avoid the confrontation with their own faces in a mirror (CFM). Objective: To investigate potential CFM-associated self-reported and psychophysiological stress reactions of DD patients, which most likely inform on the still unknown pathophysiology of dysfunctional self-perception in DD. Method: Eighteen DD patients and 18 healthy controls (HCs) underwent CFM. They were assessed for CFM-induced subjective self-reported stress, acute dissociative symptoms and sympathetic and parasympathetic drive using impedance cardiography. Results: DD patients experienced more subjective stress and acute dissociation than HCs upon CFM. Their psychological stress response did not activate the sympathetic and parasympathetic nervous system. Conclusions: In DD patients, CFM constitutes serious self-reported stress and is associated with a blunted autonomic reactivity. Therapeutic approaches promoting self-perception and self-compassion, in particular by using CFM, might serve as goal-oriented diagnostic and therapeutic tools in DD.
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Affiliation(s)
- Eva Schäflein
- Department of Psychosomatic Medicine and Psychotherapy, Klinikum rechts der Isar, Technical University of Munich, Munich, Germany
| | - Heribert Sattel
- Department of Psychosomatic Medicine and Psychotherapy, Klinikum rechts der Isar, Technical University of Munich, Munich, Germany
| | - Ulrike Schmidt
- Department of Psychiatry and Psychotherapy, University Medical Centre of Göttingen, RG Stressmodulation of Neurodegeneration, Göttingen, Germany
| | - Martin Sack
- Department of Psychosomatic Medicine and Psychotherapy, Klinikum rechts der Isar, Technical University of Munich, Munich, Germany
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34
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Brand BL, Schielke HJ, Brams JS. Assisting the Courts in Understanding and Connecting with Experiences of Disconnection: Addressing Trauma-Related Dissociation as a Forensic Psychologist, Part I. PSYCHOLOGICAL INJURY & LAW 2017. [DOI: 10.1007/s12207-017-9304-8] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
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35
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Bailey TD, Brand BL. Traumatic dissociation: Theory, research, and treatment. ACTA ACUST UNITED AC 2017. [DOI: 10.1111/cpsp.12195] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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36
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Şar V, Dorahy MJ, Krüger C. Revisiting the etiological aspects of dissociative identity disorder: a biopsychosocial perspective. Psychol Res Behav Manag 2017; 10:137-146. [PMID: 28496375 PMCID: PMC5422461 DOI: 10.2147/prbm.s113743] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/02/2022] Open
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.
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Affiliation(s)
- Vedat Şar
- Department of Psychiatry, Koç University School of Medicine, Istanbul, Turkey
| | - Martin J Dorahy
- Department of Psychology, University of Canterbury, Christchurch, New Zealand
| | - Christa Krüger
- Department of Psychiatry, University of Pretoria, Pretoria, South Africa
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37
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Chiu CD, Chang JH, Hui CM. Self-concept integration and differentiation in subclinical individuals with dissociation proneness. SELF AND IDENTITY 2017. [DOI: 10.1080/15298868.2017.1296491] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Affiliation(s)
- Chui-De Chiu
- Department of Psychology, The Chinese University of Hong Kong, Hong Kong SAR, The People’s Republic of China
| | - Jen-Ho Chang
- Institute of Ethnology, Academia Sinica, Taipei, Taiwan
| | - Chin Ming Hui
- Department of Psychology, The Chinese University of Hong Kong, Hong Kong SAR, The People’s Republic of China
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38
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Chefetz RA. Hysteria and Dissociative Processes: A Latent Multiple Self-State Model of Mind in Self Psychology. PSYCHOANALYTIC INQUIRY 2017. [DOI: 10.1080/07351690.2017.1281033] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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39
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Howard CJ. Psychospiritual Resiliency: Enhancing Mental Health and Ecclesiastical Collaboration in Caring for Those Experiencing Dissociative Phenomena. JOURNAL OF RELIGION AND HEALTH 2017; 56:258-268. [PMID: 27395050 DOI: 10.1007/s10943-016-0279-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/06/2023]
Abstract
Trauma can oftentimes be a catalyst for changes in an individual's religious and spiritual beliefs. Beliefs about the cause of the trauma, for instance, may include attributions of possessing spirits, and are to be found in an increasingly pluralistic and multicultural society. Such preternatural explanations may be referred to as dissociative identity disorder, possession form. Unwittingly, an overreliance on neurobiological explanations and relegation of cultural idioms of distress may diminish effective collaboration with ecclesiastical authorities. Concomitantly, ecclesiastical experts are confronted with bewildering posttrauma dissociative symptomatology, and may not be prepared as diagnosticians to rule out psychobiological explanations. In both instances, client care may be compromised. Noteworthy, the current investigation integrates the author's participant observation research at the Vatican's school of Exorcism in Rome, Italy.
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40
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Nijenhuis ER. Ten reasons for conceiving and classifying posttraumatic stress disorder as a dissociative disorder. EUROPEAN JOURNAL OF TRAUMA & DISSOCIATION 2017. [DOI: 10.1016/j.ejtd.2017.01.001] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
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41
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Abstract
Dissociation involves disruptions of usually integrated functions of consciousness, perception, memory, identity, and affect (e.g., depersonalization, derealization, numbing, amnesia, and analgesia). While the precise neurobiological underpinnings of dissociation remain elusive, neuroimaging studies in disorders, characterized by high dissociation (e.g., depersonalization/derealization disorder (DDD), dissociative identity disorder (DID), dissociative subtype of posttraumatic stress disorder (D-PTSD)), have provided valuable insight into brain alterations possibly underlying dissociation. Neuroimaging studies in borderline personality disorder (BPD), investigating links between altered brain function/structure and dissociation, are still relatively rare. In this article, we provide an overview of neurobiological models of dissociation, primarily based on research in DDD, DID, and D-PTSD. Based on this background, we review recent neuroimaging studies on associations between dissociation and altered brain function and structure in BPD. These studies are discussed in the context of earlier findings regarding methodological differences and limitations and concerning possible implications for future research and the clinical setting.
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42
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Trauma-related self-defining memories and future goals in Dissociative Identity Disorder. Behav Res Ther 2016; 87:216-224. [PMID: 27770748 DOI: 10.1016/j.brat.2016.10.002] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2016] [Revised: 10/04/2016] [Accepted: 10/10/2016] [Indexed: 11/21/2022]
Abstract
This study examined the content of self-defining autobiographical memories in different identities in patients with Dissociative Identity Disorder (DID) and comparison groups of patients with PTSD, healthy controls, and DID simulators. Consistent with the DID trauma model, analyses of objective ratings showed that DID patients in trauma identities retrieved more negative and trauma-related self-defining memories than DID patients in avoidant identities. Inconsistent with the DID trauma model, DID patients' self-rated trauma-relatedness of self-defining memories and future life goals did not differ between trauma identities and trauma avoidant identities. That is, the DID patients did not seem to be "shut off" from their trauma while in their avoidant identity. Furthermore, DID patients in both identities reported a higher proportion of avoidance goals compared to PTSD patients, with the latter group scoring comparably to healthy controls. The simulators behaved according to the instructions to respond differently in each identity (i.e., to report memories and goals consistent with the identity tested). The discrepant task behavior by DID patients and simulators indicated that DID patients did not seem to intentionally produce the hypothesized differences in performance between identities. In conclusion, for patients with DID (i.e., in both identities) and patients with PTSD, trauma played a central role in the retrieval of self-defining memories and in the formulation of life goals.
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43
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McKinnon MC, Boyd JE, Frewen PA, Lanius UF, Jetly R, Richardson JD, Lanius RA. A review of the relation between dissociation, memory, executive functioning and social cognition in military members and civilians with neuropsychiatric conditions. Neuropsychologia 2016; 90:210-34. [DOI: 10.1016/j.neuropsychologia.2016.07.017] [Citation(s) in RCA: 38] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2016] [Revised: 06/16/2016] [Accepted: 07/16/2016] [Indexed: 01/01/2023]
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Abstract
William James and many other early pioneers of psychology and psychiatry endorsed the notion of parallel rational conscious streams in the human mind and suggested that an understanding of multiple personalities, in what is now known as Dissociative Identity Disorder (DID), was the key to developing an appropriate model of the mind. A new meta-theory of psychology, Legion Theory, developed from an inductive study of the specific characteristics of DID, is presented. Legion Theory proposes the mind to encompass two major sets of mechanisms. The first is a set of parallel conscious streams which form the self. The second is a set of internal mental models representing the physical and other worlds. The interaction of these two sets of processes is shown to provide a model for many psychological phenomena, including abstract logical thinking and intelligence, dreams, implicit and explicit memory, state-dependent memory, psychogenic fugues, and body dysmorphia.
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45
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Vissia EM, Giesen ME, Chalavi S, Nijenhuis ERS, Draijer N, Brand BL, Reinders AATS. Is it Trauma- or Fantasy-based? Comparing dissociative identity disorder, post-traumatic stress disorder, simulators, and controls. Acta Psychiatr Scand 2016; 134:111-28. [PMID: 27225185 DOI: 10.1111/acps.12590] [Citation(s) in RCA: 35] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 04/18/2016] [Indexed: 01/18/2023]
Abstract
OBJECTIVE The Trauma Model of dissociative identity disorder (DID) posits that DID is etiologically related to chronic neglect and physical and/or sexual abuse in childhood. In contrast, the Fantasy Model posits that DID can be simulated and is mediated by high suggestibility, fantasy proneness, and sociocultural influences. To date, these two models have not been jointly tested in individuals with DID in an empirical manner. METHOD This study included matched groups [patients (n = 33) and controls (n = 32)] that were compared on psychological Trauma and Fantasy measures: diagnosed genuine DID (DID-G, n = 17), DID-simulating healthy controls (DID-S, n = 16), individuals with post-traumatic stress disorder (PTSD, n = 16), and healthy controls (HC, n = 16). Additionally, personality-state-dependent measures were obtained for DID-G and DID-S; both neutral personality states (NPS) and trauma-related personality states (TPS) were tested. CONCLUSION For Trauma measures, the DID-G group had the highest scores, with TPS higher than NPS, followed by the PTSD, DID-S, and HC groups. The DID-G group was not more fantasy-prone or suggestible and did not generate more false memories. Malingering measures were inconclusive. Evidence consistently supported the Trauma Model of DID and challenges the core hypothesis of the Fantasy Model.
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Affiliation(s)
- E M Vissia
- Department of Neuroscience, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - M E Giesen
- Department of Neuroscience, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - S Chalavi
- Department of Neuroscience, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands.,Department of Biomedical Kinesiology, Research Center for Movement Control and Neuroplasticity, KU Leuven, Leuven, Belgium
| | - E R S Nijenhuis
- Clienia Littenheid, Psychiatrische Klinik, Littenheid, Switzerland
| | - N Draijer
- Department of Psychiatry, VU University Medical Center, Amsterdam, The Netherlands
| | - B L Brand
- Psychology Department, Towson University, Towson, MD, USA
| | - A A T S Reinders
- Department of Neuroscience, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands.,Department of Psychosis Studies, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
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46
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Brand BL, Sar V, Stavropoulos P, Krüger C, Korzekwa M, Martínez-Taboas A, Middleton W. Separating Fact from Fiction: An Empirical Examination of Six Myths About Dissociative Identity Disorder. Harv Rev Psychiatry 2016; 24:257-70. [PMID: 27384396 PMCID: PMC4959824 DOI: 10.1097/hrp.0000000000000100] [Citation(s) in RCA: 51] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/29/2014] [Revised: 01/27/2015] [Accepted: 05/22/2015] [Indexed: 01/08/2023]
Abstract
Dissociative identity disorder (DID) is a complex, posttraumatic, developmental disorder for which we now, after four decades of research, have an authoritative research base, but a number of misconceptualizations and myths about the disorder remain, compromising both patient care and research. This article examines the empirical literature pertaining to recurrently expressed beliefs regarding DID: (1) belief that DID is a fad, (2) belief that DID is primarily diagnosed in North America by DID experts who overdiagnose the disorder, (3) belief that DID is rare, (4) belief that DID is an iatrogenic, rather than trauma-based, disorder, (5) belief that DID is the same entity as borderline personality disorder, and (6) belief that DID treatment is harmful to patients. The absence of research to substantiate these beliefs, as well as the existence of a body of research that refutes them, confirms their mythical status. Clinicians who accept these myths as facts are unlikely to carefully assess for dissociation. Accurate diagnoses are critical for appropriate treatment planning. If DID is not targeted in treatment, it does not appear to resolve. The myths we have highlighted may also impede research about DID. The cost of ignorance about DID is high not only for individual patients but for the whole support system in which they reside. Empirically derived knowledge about DID has replaced outdated myths. Vigorous dissemination of the knowledge base about this complex disorder is warranted.
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Affiliation(s)
- Bethany L Brand
- From Towson University (Dr. Brand); Koç University School of Medicine (Istanbul) (Dr. Sar); Blue Knot Foundation, Sydney, Australia (Dr. Stavropoulos); University of Pretoria (Dr. Krüger); McMaster University (Dr. Korzekwa); Carlos Albizu University (San Juan) (Dr. Martínez-Taboas); Latrobe University, University of New England, University of Canterbury (New Zealand), and University of Queensland (Australia) (Dr. Middleton)
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Abstract
The etiology of dissociative identity disorder (DID) remains a topic of debate. Proponents of the fantasy model and the trauma model of DID have both called for more empirical research. To this end, the current study presents new and extended data analyses of a previously published H2O positron emission tomography imaging study. This study included 29 subjects: 11 patients with DID and 10 high- and 8 low-fantasy-prone DID-simulating mentally healthy control subjects. All subjects underwent an autobiographical memory script-driven (neutral and trauma related) imagery paradigm in 2 (simulated) dissociative personality states (neutral and trauma related). Psychobiological and psychophysiological data were obtained. Results of the new post-hoc tests on the psychophysiological responses support the trauma model. New results of the brain imaging data did not support the fantasy model. This study extends previously published results by offering important new supporting data for the trauma model of DID.
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48
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Strasburger H, Waldvogel B. Sight and blindness in the same person: Gating in the visual system. Psych J 2015; 4:178-85. [DOI: 10.1002/pchj.109] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2015] [Accepted: 08/01/2015] [Indexed: 11/07/2022]
Affiliation(s)
- Hans Strasburger
- Institute of Medical Psychology; Ludwig Maximilian University; Munich Germany
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49
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Chalavi S, Vissia EM, Giesen ME, Nijenhuis ER, Draijer N, Cole JH, Dazzan P, Pariante CM, Madsen SK, Rajagopalan P, Thompson PM, Toga AW, Veltman DJ, Reinders AA. Abnormal hippocampal morphology in dissociative identity disorder and post-traumatic stress disorder correlates with childhood trauma and dissociative symptoms. Hum Brain Mapp 2015; 36:1692-704. [PMID: 25545784 PMCID: PMC4400262 DOI: 10.1002/hbm.22730] [Citation(s) in RCA: 53] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2014] [Revised: 12/09/2014] [Accepted: 12/15/2014] [Indexed: 01/17/2023] Open
Abstract
Smaller hippocampal volume has been reported in individuals with post-traumatic stress disorder (PTSD) and dissociative identity disorder (DID), but the regional specificity of hippocampal volume reductions and the association with severity of dissociative symptoms and/or childhood traumatization are still unclear. Brain structural magnetic resonance imaging scans were analyzed for 33 outpatients (17 with DID and 16 with PTSD only) and 28 healthy controls (HC), all matched for age, sex, and education. DID patients met criteria for PTSD (PTSD-DID). Hippocampal global and subfield volumes and shape measurements were extracted. We found that global hippocampal volume was significantly smaller in all 33 patients (left: 6.75%; right: 8.33%) compared with HC. PTSD-DID (left: 10.19%; right: 11.37%) and PTSD-only with a history of childhood traumatization (left: 7.11%; right: 7.31%) had significantly smaller global hippocampal volume relative to HC. PTSD-DID had abnormal shape and significantly smaller volume in the CA2-3, CA4-DG and (pre)subiculum compared with HC. In the patient groups, smaller global and subfield hippocampal volumes significantly correlated with higher severity of childhood traumatization and dissociative symptoms. These findings support a childhood trauma-related etiology for abnormal hippocampal morphology in both PTSD and DID and can further the understanding of neurobiological mechanisms involved in these disorders.
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Affiliation(s)
- Sima Chalavi
- Department of NeuroscienceUniversity Medical Center Groningen, University of GroningenGroningenThe Netherlands
- Research Center for Movement Control and NeuroplasticityDepartment of Biomedical KinesiologyKU LeuvenLeuvenBelgium
| | - Eline M. Vissia
- Department of NeuroscienceUniversity Medical Center Groningen, University of GroningenGroningenThe Netherlands
| | - Mechteld E. Giesen
- Department of NeuroscienceUniversity Medical Center Groningen, University of GroningenGroningenThe Netherlands
| | | | - Nel Draijer
- Department of PsychiatryVU University Medical CenterAmsterdamThe Netherlands
| | - James H. Cole
- Computational, Cognitive, and Clinical Neuroimaging LaboratoryDivision of Brain Sciences, Imperial College London, Burlington Danes Building, Hammersmith HospitalLondonUnited Kingdom
| | - Paola Dazzan
- Department of Psychosis StudiesInstitute of Psychiatry, King's College LondonLondonUnited Kingdom
- National Institute for Health Research (NIHR) Mental Health Biomedical Research Centre at South London and Maudsley NHS Foundation Trust and King's College LondonUnited Kingdom
| | - Carmine M. Pariante
- Department of Psychological MedicineInstitute of Psychiatry, King's College LondonLondonUnited Kingdom
| | - Sarah K. Madsen
- Imaging Genetics Center, Institute for Neuroimaging and Informatics, Laboratory of Neuro ImagingKeck School of Medicine, University of Southern CaliforniaLos AngelesCalifornia
| | - Priya Rajagopalan
- Imaging Genetics Center, Institute for Neuroimaging and Informatics, Laboratory of Neuro ImagingKeck School of Medicine, University of Southern CaliforniaLos AngelesCalifornia
- Indiana University‐Purdue UniversityIndianapolisIndiana
| | - Paul M. Thompson
- Imaging Genetics Center, Institute for Neuroimaging and Informatics, Laboratory of Neuro ImagingKeck School of Medicine, University of Southern CaliforniaLos AngelesCalifornia
| | - Arthur W. Toga
- Imaging Genetics Center, Institute for Neuroimaging and Informatics, Laboratory of Neuro ImagingKeck School of Medicine, University of Southern CaliforniaLos AngelesCalifornia
| | - Dick J. Veltman
- Department of PsychiatryVU University Medical CenterAmsterdamThe Netherlands
| | - Antje A.T.S. Reinders
- Department of NeuroscienceUniversity Medical Center Groningen, University of GroningenGroningenThe Netherlands
- Department of Psychosis StudiesInstitute of Psychiatry, King's College LondonLondonUnited Kingdom
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50
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Similar cortical but not subcortical gray matter abnormalities in women with posttraumatic stress disorder with versus without dissociative identity disorder. Psychiatry Res 2015; 231:308-19. [PMID: 25670646 DOI: 10.1016/j.pscychresns.2015.01.014] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/11/2014] [Revised: 11/21/2014] [Accepted: 01/13/2015] [Indexed: 11/21/2022]
Abstract
Neuroanatomical evidence on the relationship between posttraumatic stress disorder (PTSD) and dissociative disorders is still lacking. We acquired brain structural magnetic resonance imaging (MRI) scans from 17 patients with dissociative identity disorder (DID) and co-morbid PTSD (DID-PTSD) and 16 patients with PTSD but without DID (PTSD-only), and 32 healthy controls (HC), and compared their whole-brain cortical and subcortical gray matter (GM) morphological measurements. Associations between GM measurements and severity of dissociative and depersonalization/derealization symptoms or lifetime traumatizing events were evaluated in the patient groups. DID-PTSD and PTSD-only patients, compared with HC, had similarly smaller cortical GM volumes of the whole brain and of frontal, temporal and insular cortices. DID-PTSD patients additionally showed smaller hippocampal and larger pallidum volumes relative to HC, and larger putamen and pallidum volumes relative to PTSD-only. Severity of lifetime traumatizing events and volume of the hippocampus were negatively correlated. Severity of dissociative and depersonalization/derealization symptoms correlated positively with volume of the putamen and pallidum, and negatively with volume of the inferior parietal cortex. Shared abnormal brain structures in DID-PTSD and PTSD-only, small hippocampal volume in DID-PTSD, more severe lifetime traumatizing events in DID-PTSD compared with PTSD-only, and negative correlations between lifetime traumatizing events and hippocampal volume suggest a trauma-related etiology for DID. Our results provide neurobiological evidence for the side-by-side nosological classification of PTSD and DID in the DSM-5.
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