Abstract
Dissociative disorders (DDs) involve a disconnection from the present moment including one’s emotions, body, or surroundings, frequently in an effort to regulate internal states (e.g., emotions, overwhelming levels of physical arousal) during times of heightened stress. The development of a DD has most consistently been associated with antecedent trauma, particularly when exposure happens repeatedly in childhood (Dalenberg et al., 2012, 2014). To further understand DDs, we begin by presenting common symptoms, followed by a discussion of the current diagnostic criteria, prevalence, and difficulties with accurate diagnosis. Further, we discuss strategies for gathering information, including interviews, psychological measures (e.g., self-report and performance-based), and behavioral observations. We conclude with factors to consider when ruling out other diagnoses with similar presentations, such as schizophrenia or borderline personality disorder.
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Notes
- 1.
The case examples included in this chapter have been de-identified and altered to protect the clients’ confidentiality.
References
American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders DSM-5 (5th ed.). Washington, DC: American Psychiatric Press.
Armstrong, J. G. (1992). Keeping one’s balance in a moving system: The effects of the multiple personality disordered patient on the cognitive development of the therapist. In J. D. Sinnott & J. Cavanaugh (Eds.), Bridging paradigms: Positive development in adulthood and cognitive aging. New York, NY: Praeger.
Bernstein, E. M., & Putnam, F. W. (1986). Development, reliability, and validity of a dissociation scale. Journal of Nervous and Mental Disease, 174, 727–735.
Brand, B. L. (2016). The necessity of clinical training in trauma and dissociation. Journal of Anxiety and Depression, 5(4), 251. https://doi.org/10.4172/2167-1044.1000251
Brand, B. L., Armstrong, J. G., & Loewenstein, R. J. (2006). Psychological assessment of patients with dissociative identity disorder. The Psychiatric Clinics of North America, 29(1), 145–168.
Brand, B. L., Armstrong, J. G., Loewenstein, R. J., & McNary, S. W. (2009). Personality differences on the Rorschach of dissociative identity disorder, borderline personality disorder, and psychotic inpatients. Psychological Trauma: Theory, Research, Practice, and Policy, 1(3), 188–205.
Brand, B. L., & Chasson, G. S. (2015). Distinguishing simulated from genuine dissociative identity disorder on the MMPI-2. Psychological Trauma: Theory, Research, Practice, and Policy, 7(1), 93–101. https://doi.org/10.1037/a0035181
Brand, B. L., Chasson, G. S., Palermo, C. A., Donato, F. M., Rhodes, K. P., & Voorhees, E. F. (2016). MMPI-2 item endorsements in dissociative identity disorder vs. simulators. The Journal of the American Academy of Psychiatry and the Law, 44(1), 63–72.
Brand, B. L., & Loewenstein, R. J. (2010). Dissociative disorders: An overview of assessment, phenomenology and treatment. Psychiatric Times, 27(10), 62–69.
Brand, B. L., & Loewenstein, R. J. (2014). Does phasic trauma treatment make patients with dissociative identity disorder treatment more dissociative? Journal of Trauma & Dissociation, 15(1), 52–65.
Brand, B. L., Tursich, M., Tzall, D., & Loewenstein, R. J. (2014). Utility of the SIRS-2 in distinguishing genuine from simulated dissociative identity disorder. Psychological Trauma: Theory, Research, Practice, and Policy, 6(4), 308–317.
Brand, B. L., Webermann, A. R., Snyder, B. L., & Kaliush, P. R. (2018). Detecting genuine and simulated dissociative identity disorder with the test of memory malingering. Psychological Trauma: Theory, Research, and Practice. https://doi.org/10.1037/tra0000405
Briere, J. (2001). Detailed assessment of posttraumatic stress. Odessa, FL: Psychological Assessment Resources.
Briere, J. (2002). The multiscale dissociation inventory (MDI) professional manual. Lutz, FL: Psychological Assessment Resources.
Briere, J. (2011). Trauma symptom inventory-2 (TSI-2): Professional manual. Lutz, FL: Psychological Assessment Resources.
Briere, J., Dietrich, A., & Semple, R. J. (2016). Dissociative complexity: Antecedents and clinical correlates of a new construct. Psycholical Trauma: Theory, Research, Practice, and Policy, 8(5), 577–584. https://doi.org/10.1037/tra0000126
Brown, L. S. (2008). Cultural competence in trauma therapy: Beyond the flashback. Washington, DC: American Psychological Association.
Butcher, J. N., Graham, J. R., Ben-Porath, Y. S., Tellegen, A., & Dahlstrom, W. G. (2001). Manual for the administration and scoring of the MMPI–2. Minneapolis, MN: Minnesota University Press.
Coons, P. M., & Milstein, V. (1990). Self-mutilation associated with dissociative disorders. Dissocation, 3(2), 81–87.
Cronin, E., Brand, B. L., & Mattanah, J. F. (2014). The impact of the therapeutic alliance on treatment outcome in patients with dissociative disorders. European Journal of Psychotraumatology, 5. https://doi.org/10.3402/ejpt.v5.22676
Dalenberg, C. J., Brand, B. L., Gleaves, D. H., Dorahy, M. J., Loewenstein, R. J., Cardena, E., … Spiegel, D. (2012). Evaluation of the evidence for the trauma and fantasy models of dissociation. Psychological Bulletin, 138(3), 550–588. https://doi.org/10.1037/a0027447
Dalenberg, C. J., Brand, B. L., Loewenstein, R. J., Gleaves, D. H., Dorahy, M. J., Cardeña, E., … Spiegel, D. (2014). Reality versus fantasy: Reply to Lynn et al. (2014). Psychological Bulletin, 140(3), 911–920.
Dell, P. F. (2002). Dissociative phenomenology of dissociative identity disorder. The Journal of Nervous and Mental Disease, 190(1), 10–15.
Dell, P. F. (2006a). A mew model of dissociative identity disorder. Psychiatric Clinics of North America, 29(1), 1–26.
Dell, P. F. (2006b). The multidimensional inventory of dissociation (MID): A comprehensive measure of pathological dissociation. Journal of Trauma & Dissociation, 7(2), 77–106.
Dorahy, M. J., Brand, B. L., Şar, V., Krüger, C., Stavropoulos, P., Martínez-Taboas, A., … Middleton, W. (2014). Dissociative identity disorder: An empirical overview. Australian and New Zealand Journal of Psychiatry, 48(5), 402–417.
Dorahy, M. J., Lewis, C. A., & Mulholland, C. (2005). The detection of dissociative identity disorder by northern Irish clinical psychologists and psychiatrists: A clinical vignettes study. Journal of Trauma & Dissociation, 6(4), 39–50. https://doi.org/10.1300/J229v06n04_03
Dorahy, M. J., Shannon, C., Seagar, L., Corr, M., Stewart, K., Hanna, D., … Middleton, W. (2009). Auditory hallucinations in dissociative identity disorder and schizophrenia with and without a childhood trauma history: Similarities and differences. Journal of Nervous and Mental Disease, 197(12), 892–898. https://doi.org/10.1097/NMD.0b013e3181c299ea
Exner, J. E., & Erdberg, P. (2005). The Rorschach: A comprehensive system (3rd ed.). Hoboken, NJ: Wiley.
Foote, B., Smolin, Y., Neft, D. I., & Lipschitz, D. (2008). Dissociative disorders and suicidality in psychiatric outpatients. Journal of Nervous and Mental Disease, 196(1), 29–36.
Frewen, P. A., & Lanius, R. (2015). Healing the traumatized self: Consciousness, neuroscience, treatment. New York, NY: W. W. Norton & Company.
Hays, P. A. (2016). Addressing cultural complexities in practice: Assessment, diagnosis, and therapy (3rd ed.). Washington, DC: American Psychological Association.
Herman, J. L. (1997). Trauma and recovery: The aftermath of violence--from domestic abuse to political terror. New York, NY: Basic Books.
International Society for the Study of Dissociation, Chu, J. A., Dell, P. F., Somer, E., Van der Hart, O., Cardeña, E., … Twombly, J. (2011). Guidelines for treating dissociative identity disorder in adults, third revision. Journal of Trauma and Dissociation, 12(2), 115–187. https://doi.org/10.1080/15299732.2011.537247
Kluft, R. P. (1987a). First-rank symptoms as a diagnostic clue to multiple personality disorder. The American Journal of Psychiatry, 144(3), 293–298.
Kluft, R. P. (1987b). The simulation and dissimulation of multiple personality disorder. American Journal of Clinical Hypnosis, 30, 104–118.
Lanius, R. A., Brand, B. L., Vermetten, E., Frewen, P. A., & Spiegel, D. (2012). The dissociative subtype of posttraumatic stress disorder: Rationale, clinical and neurobiological evidence, and implications. Depression and Anxiety, 29(8), 701–708. https://doi.org/10.1002/da.21889
Leonard, D., Brann, S., & Tiller, J. (2005). Dissociative disorders: Pathways to diagnosis, clinician attitudes and their impact. The Australian and New Zealand Journal of Psychiatry, 39(10), 940–946.
Loewenstein, R. J. (1991). An office mental status examination for complex chronic dissociative symptoms and multiple personality disorder. Psychiatric Clinics of North America, 14(3), 567–604.
Longden, E., Madill, A., & Waterman, M. G. (2012). Dissociation, trauma, and the role of lived experience: Toward a new conceptualization of voice hearing. Psychological Bulletin, 138(1), 28–76. https://doi.org/10.1037/a0025995
Lyssenko, L., Schmahl, C., Bockhacker, L., Vonderlin, R., Bohus, M., & Kleindienst, N. (2018). Dissociation in psychiatric disorders: A meta-analysis of studies using the dissociative experiences scale. American Journal of Psychiatry, 175(1), 37–46.
Mendez, N., Martinez-Taboas, A., & Pedrosa, O. (2000). Experiences, beliefs and attitudes of Puerto Rican psychologists toward dissociative identity disorder. Ciencias de la Conducta, 15, 69–84.
Murray, H. A. (1943). Thematic apperception test. Cambridge, MA: Harvard University Press.
Nijenhuis, E. R. S., Spinhoven, P., Van Dyck, R., Van Der Hart, O., & Vanderlinden, J. (1996). The development and psychometric characteristics of the somatoform dissociation questionnaire (SDQ-20). Journal of Nervous and Mental Disease, 184(11), 688–694. https://doi.org/10.1097/00005053-199611000-00006
Palermo, C. A., & Brand, B. L. (2018). Can the trauma symptom Inventory-2 distinguish coached simulators from dissociative disorder patients? Psychological Trauma: Theory, Research, Practice, & Policy. https://doi.org/10.1037/tra0000382
Perniciaro, L. A. (2015). The influence of skepticism and clinical experience on the detection of dissociative identity disorder by mental health clinicians. (75), ProQuest Information & Learning, US. Retrieved from http://proxy-tu.researchport.umd.edu/login?ins=tu&url=http://search.ebscohost.com/login.aspx?direct=true&db=psyh&AN=2015-99080-169&site=ehost-live. Available from EBSCOhost psyh database.
Pica, M., Beere, D., Lovinger, S., & Dush, D. (2001). The responses of dissociative patients on the thematic apperception test. Journal of Clinical Psychology, 57(7), 847–864.
Platt, M. G., Luoma, J. B., & Freyd, J. J. (2016). Shame and dissociation in survivors of high and low betrayal trauma. Journal of Aggression, Maltreatment & Trauma, 26(1), 34–49. https://doi.org/10.1080/10926771.2016.1228020
Putnam, F. W. (1989). Diagnosis and treatment of multiple personality disorder. New York, NY: Guilford Press.
Putnam, F. W. (1997). Dissociation in children and adolescents: A developmental perspective. New York, NY: Guilford Press.
Rogers, R., Sewell, K. W., & Gillard, N. D. (2010). Structured innterview of reported symptoms-2 (SIRS-2) and professional manual. Lutz, FL: Psychological Assessment Resources.
Ross, C. A. (n.d.). The dissociative disorders interview schedule – DSM-5 version. Retrieved from http://www.rossinst.com/downloads/DDIS-DSM-5.pdf
Ross, C. A., Miller, S. D., Reagor, P., Bjornson, L., Fraser, G. A., & Anderson, G. (1990). Schneiderian symptoms in multiple personality disorder and schizophrenia. Comprehensive Psychiatry, 31, 111–118.
Sar, V. (2011). Epidemiology of dissociative disorders: An overview. Epidemiology Research International. https://doi.org/10.1155/2011/404538
Schore, A. (2009). Attachment trauma and the developing right brain: Origins of pathological dissociation. In P. F. Dell & J. A. O’Neil (Eds.), Dissociation and the dissociative disorders: DSM-V and beyond (pp. 107–141). New York, NY: Routledge/Taylor & Francis Group.
Sierra, M., & Berrios, G. E. (2000). The Cambridge depersonalisation scale: A new instrument for the measurement of depersonalisation. Psychiatry Research, 93(2), 153–164.
Stadnik, R. D., Brand, B. L., & Savoca, A. (2013). Personality assessment inventory profile and predictors of elevations among dissociative disorder patients. Journal of Trauma & Dissociation, 14(5), 546–561. https://doi.org/10.1080/15299732.2013.792310
Steele, K., Boon, S., & van der Hart, O. (2017). Treating trauma-rleated dissociation: A practical, integrated approach. New York, NY: W. W. Norton & Company.
Steinberg, M., Rounsaville, B., & Cicchetti, D. (1990). The structured clinical interview for DSM-III-R dissociative disorders: A preliminary report. American Journal of Psychiatry, 147, 76–82.
Steinberg, M. (1993). The structured clinical interview for DSM-III-R dissociative disorders (SCID-D). Washington, DC: American Psychiatric Press.
Steinberg, M. (1994). The structured clinical interview for DSM-IV dissociative disorders-revised (SCID-D-R). Washington, D.C.: American Psychiatric Press.
Steinberg, M. (2001). Updating diagnostic criteria for dissociative disorders: Learning from scientific advances. Journal of Trauma and Dissociation, 2, 59–63.
Stoltenborgh, M., Bakermans-Kranenburg, M. J., Alink, L. R. A., & van Ijzendoorn, M. H. (2015). The prevalence of child maltreatment across the globe: Review of a series of meta-analyses. Child Abuse Review, 24(1), 37–50. https://doi.org/10.1002/car.2353
Tombaugh, T. N. (2002). The Test of Memory Malingering (TOMM) in forensic psychology. Journal of Forensic Neuropsychology, 2(3–4), 69–96. https://doi.org/10.1300/J151v02n03_04
Waller, N., Putnam, F. W., & Carlson, E. B. (1996). Types of dissociation and dissociative types: A taxometric analysis of dissociative experiences. Psychological Methods, 1(3), 300–321. https://doi.org/10.1037/1082-989X.1.3.300
Wolf, G. K., Reinhard, M., Cozolino, L. J., Caldwell, A., & Asamen, J. K. (2009). Neuropsychiatric symptoms of complex posttraumatic stress disorder: A preliminary Minnesota multiphasic personality inventory scale to identify adult survivors of childhood abuse. Psychological Trauma: Theory, Research, Practice, and Policy, 1(1), 49–64.
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Bailey, T.D., Boyer, S.M., Brand, B.L. (2019). Dissociative Disorders. In: Segal, D.L. (eds) Diagnostic Interviewing. Springer, New York, NY. https://doi.org/10.1007/978-1-4939-9127-3_16
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