When dreams become a royal road to confusion: realistic dreams, dissociation, and fantasy proneness

When Imagination Feels Like Reality: A Case Study of False Memories and Maladaptive Daydreaming in Visual Impairment

Background

When a person experiences maladaptive daydreaming (MD), they spend a prolonged period daydreaming with a strong sense of presence. The symptoms of MD are often excessive, interfere with functioning, and are linked to distress and comorbid mental disorders. In this paper, apparent false memory is described in the context of a woman with MD and visual impairment due to a progressive eye condition. Her vivid daydreams seemed indistinguishable from actual memories. Case Report. A 35-year-old woman with a lifelong MD reported three incidents of fabricating detailed false memories of events that her family confirmed never occurred: obtaining a new job, miscarrying twins, and hospitalization for COVID-19. She experienced anxiety and shame when the stories were disproven. The assessment confirmed MD, PTSD, OCD, and other disorders. Her verbal memory was below average, especially for longer narratives. Her misattributions of daydreams as real-life memories may relate to reliance on vivid mental images over deteriorating vision and source monitoring deficits.

Conclusion

This first reported case of confabulations in an individual with MD and visual disability suggests daydreams could potentially be mistaken for actual events in some MD cases. While sensitive, more research is needed on the prevalence of false memories among individuals with MD. The default mode network, prefrontal cortex, and their connectivity may be implicated in generating vivid daydreams and misattributing them to actual episodic events. Understanding the relationship between sensory impairments, dissociation, and susceptibility to memory distortions could inform interventions to improve reality testing for some MD patients.

Creating Memories for False Autobiographical Events in Childhood: A Systematic Review

Using a framework that distinguishes autobiographical belief, recollective experience, and confidence in memory, we review three major paradigms used to suggest false childhood events to adults: imagination inflation, false feedback and memory implantation. Imagination inflation and false feedback studies increase the belief that a suggested event occurred by a small amount such that events are still thought unlikely to have happened. In memory implantation studies, some recollective experience for the suggested events is induced on average in 47% of participants, but only in 15% are these experiences likely to be rated as full memories. We conclude that susceptibility to false memories of childhood events appears more limited than has been suggested. The data emphasise the complex judgements involved in distinguishing real from imaginary recollections and caution against accepting investigator‐based ratings as necessarily corresponding to participants' self‐reports. Recommendations are made for presenting the results of these studies in courtroom settings. © 2016 The Authors Applied Cognitive Psychology Published by John Wiley & Sons Ltd.

Dream-reality confusion in borderline personality disorder: a theoretical analysis

This paper presents an analysis of dream-reality confusion (DRC) in relation to the characteristics of borderline personality disorder (BPD), based on research findings and theoretical considerations. It is hypothesized that people with BPD are more likely to experience DRC compared to people in non-clinical population. Several variables related to this hypothesis were identified through a theoretical analysis of the scientific literature. Sleep disturbances: problems with sleep are found in 15–95.5% of people with BPD (Hafizi, 2013), and unstable sleep and wake cycles, which occur in BPD (Fleischer et al., 2012), are linked to DRC. Dissociation: nearly two-thirds of people with BPD experience dissociative symptoms (Korzekwa and Pain, 2009) and dissociative symptoms are correlated with a fantasy proneness; both dissociative symptoms and fantasy proneness are related to DRC (Giesbrecht and Merckelbach, 2006). Negative dream content: People with BPD have nightmares more often than other people (Semiz et al., 2008); dreams that are more likely to be confused with reality tend to be more realistic and unpleasant, and are reflected in waking behavior (Rassin et al., 2001). Cognitive disturbances: Many BPD patients experience various cognitive disturbances, including problems with reality testing (Fiqueierdo, 2006; Mosquera et al., 2011), which can foster DRC. Thin boundaries: People with thin boundaries are more prone to DRC than people with thick boundaries, and people with BPD tend to have thin boundaries (Hartmann, 2011). The theoretical analysis on the basis of these findings suggests that people who suffer from BPD may be more susceptible to confusing dream content with actual waking events.

Delusional confusion of dreaming and reality in narcolepsy

STUDY OBJECTIVES

We investigated a generally unappreciated feature of the sleep disorder narcolepsy, in which patients mistake the memory of a dream for a real experience and form sustained delusions about significant events.

DESIGN

We interviewed patients with narcolepsy and healthy controls to establish the prevalence of this complaint and identify its predictors.

SETTING

Academic medical centers in Boston, Massachusetts and Leiden, The Netherlands.

PARTICIPANTS

Patients (n = 46) with a diagnosis of narcolepsy with cataplexy, and age-matched healthy healthy controls (n = 41).

INTERVENTIONS

N/A.

MEASUREMENTS AND RESULTS

"Dream delusions" were surprisingly common in narcolepsy and were often striking in their severity. As opposed to fleeting hypnagogic and hypnopompic hallucinations of the sleep/wake transition, dream delusions were false memories induced by the experience of a vivid dream, which led to false beliefs that could persist for days or weeks.

CONCLUSIONS

The delusional confusion of dreamed events with reality is a prominent feature of narcolepsy, and suggests the possibility of source memory deficits in this disorder that have not yet been fully characterized.

Fact or factitious? A psychobiological study of authentic and simulated dissociative identity states

BACKGROUND

Dissociative identity disorder (DID) is a disputed psychiatric disorder. Research findings and clinical observations suggest that DID involves an authentic mental disorder related to factors such as traumatization and disrupted attachment. A competing view indicates that DID is due to fantasy proneness, suggestibility, suggestion, and role-playing. Here we examine whether dissociative identity state-dependent psychobiological features in DID can be induced in high or low fantasy prone individuals by instructed and motivated role-playing, and suggestion.

METHODOLOGY/PRINCIPAL FINDINGS

DID patients, high fantasy prone and low fantasy prone controls were studied in two different types of identity states (neutral and trauma-related) in an autobiographical memory script-driven (neutral or trauma-related) imagery paradigm. The controls were instructed to enact the two DID identity states. Twenty-nine subjects participated in the study: 11 patients with DID, 10 high fantasy prone DID simulating controls, and 8 low fantasy prone DID simulating controls. Autonomic and subjective reactions were obtained. Differences in psychophysiological and neural activation patterns were found between the DID patients and both high and low fantasy prone controls. That is, the identity states in DID were not convincingly enacted by DID simulating controls. Thus, important differences regarding regional cerebral bloodflow and psychophysiological responses for different types of identity states in patients with DID were upheld after controlling for DID simulation.

CONCLUSIONS/SIGNIFICANCE

The findings are at odds with the idea that differences among different types of dissociative identity states in DID can be explained by high fantasy proneness, motivated role-enactment, and suggestion. They indicate that DID does not have a sociocultural (e.g., iatrogenic) origin.

Fragmented Sleep, Fragmented Mind

In psychopathology, dissociation typically refers to a disturbance in the normal integration of thoughts, feelings, and experiences into consciousness and memory. In this article, we review the literature on how sleep disturbances relate to dissociative symptoms and memory failure. We contend that this body of research offers a fresh perspective on dissociation. Specifically, we argue that dissociative symptoms are associated with a labile sleep–wake cycle, in which dreamlike mentation invades the waking state, produces memory failures, and fuels dissociative experiences. The research domain of sleep and dissociation can accommodate the dominant idea in the clinical literature that trauma is the distal cause of dissociation, and it holds substantial promise to inspire new treatments for dissociative symptoms (e.g., interventions that focus on normalization of the sleep-wake cycle). We conclude with worthwhile paths for further investigations and suggest that the sleep–dissociation approach may help reconcile competing interpretations of dissociative symptoms.

Nazi cruelties: Are they literally hard to imagine?

In four experiments, the characteristics of participants' mental imagery of World War II were investigated. In the first experiment, mental images of WWII were found to lack clarity compared to mental images of a Medieval war. In a second experiment, the association between the lack of clarity of WWII mental images, and the underestimation of Nazi cruelties was explored. In line with the expectation based on source monitoring theory, participants whose mental imagery was less clear more readily endorsed an item modelling denial of Nazi cruelties. In a third experiment, these findings were replicated. In experiment 4, participants' WWII mental images were manipulated by means of film footage. Ultimately, it is argued that viewing film footage of poor quality results in unclear mental images of WWII, and that lack of clarity of WWII imagery is associated with a tendency to Nazi cruelties.

Reality monitoring in adults reporting repressed, recovered, or continuous memories of childhood sexual abuse

People who report either repressed or recovered memories of childhood sexual abuse (CSA) may have deficits in reality monitoring--the process whereby one discriminates memories of percepts from memories of images. Using signal detection methods, the authors found that adults reporting either repressed or recovered memories of CSA were less able to discriminate between words they had seen from words they had imagined seeing than were adults reporting either never having forgotten their CSA or adults reporting no history of CSA. Relative deficits in the ability to discriminate percepts from images (i.e., low d') were apparent on only some tests. The groups did not differ in their criterion--response bias--for affirming having seen versus imagined stimuli.

What's in a Name for Memory Errors? Implications and Ethical Issues Arising From the Use of the Term "False Memory" for Errors in Memory for Details

The term "false memories" has been used to refer to suggestibility experiments in which whole events are apparently confabulated and in media accounts of contested memories of childhood abuse. Since 1992 psychologists have increasingly used the term "false memory" when discussing memory errors for details, such as specific words within lists. Use of the term to refer to errors in details is a shift in language away from other terms used historically (e.g., "memory intrusions"). We empirically examine this shift in language and discuss implications of the new use of the term "false memories." Use of the term presents serious ethical challenges to the data-interpretation process by encouraging over-generalization and misapplication of research findings on word memory to social issues.

Testing the dissociative taxon

A dissociative taxon has been proposed by Waller et al. (1996) to help identify individuals experiencing pathological dissociation. We studied the frequency of taxon membership and tested its validity. A total of 276 students and 204 psychiatric inpatients completed the Dissociative Experiences Scale (DES). In patients with higher DES ratings, the Dissociative Disorders Interview Schedule was administered. Taxon classification applied to 2.9% of non-patients and to 12.7% of patients. No statistically significant relationship was found between taxon membership and the clinical diagnosis of a dissociative disorder. Taxon membership indicates a higher frequency of dissociative experiences but cannot be equated with the presence of a dissociative disorder.