Assessment of Genuine and Simulated Dissociative Identity Disorder on the Structured Interview of Reported Symptoms

ABSTRACT

Little is known about how to detect malingered dissociative identity disorder (DID). This study presents preliminary data from an ongoing study about the performance of DID patients on the Structured Interview of Reported Symptoms (SIRS, Rogers, Bagby, & Dickens, 1992), considered to be a “gold standard” structured interview in forensic psychology to detect feigning of psychological symptoms. Test responses from 20 dissociative identity disorder (DID) patients are compared to those of 43 well informed and motivated DID simulators. Both the simulators and DID patients endorsed such a high number of symptoms that their average overall scores would typically be interpreted as indicative of feigning. The simulators' mean scores were significantly higher than those of the DID patients on only four out of 13 scales. These results provide preliminary evidence that well informed and motivated simulators are able to fairly successfully simulate DID patients and avoid detection on the SIRS. Furthermore, many DID patients may be at risk for being inaccurately labeled as feigning on the SIRS.     

Relationship between religiosity,religious coping and socio-demographic variables among out-patients with depression or diabetes mellitus in Enugu,Nigeria

BackgroundReligion is a powerful coping strategy. Diabetes and depression are common conditions in our environment that induce psychological distress, thus requiring coping for better outcome. Studies indicate that increased religiosity is associated with better outcome in clinical and general populations. Therefore, studies of the distribution of religiosity and religious coping among these populations are essential to improve outcome.ObjectivesTo assess the association between religiosity, religious coping in depression and diabetes mellitus, and selected sociodemographic variables (age, gender and occupational status).MethodsUsing simple random sampling we recruited 112 participants with diabetes and an equal number with depression consecutively, matching for gender. Religiosity was determined using religious orientation scale (revised), religious coping with brief religious coping scale and socio-demographic variables with a socio-demographic questionnaire.ResultsIntrinsic religiosity was greater among older people with depression than among older people with diabetes(t=5.02,p<0.001); no significant difference among young people with depression and diabetes(t=1.47,p=0.15).Positive religious coping was greater among older people with depression than among older people with diabetes(t=2.31,p=0.02); no difference among young people with depression and diabetes(t=0.80,p=0.43). Females with depression had higher intrinsic religiosity scores than males with depression(t=3.85,p<0.001); no difference in intrinsic religiosity between females and males with diabetes(t=0.99,p=0.32).Positive religious coping was greater among participants with diabetes in the low occupational status(t=2.96,p<0.001) than those in the high occupational status.ConclusionReligion is indeed a reliable coping method, most commonly used by the elderly and females with depression. Positive religious coping is more common among diabetic patients who are in the low occupational status.     

Differential Diagnosis between Anomalous Experiences and Dissociation Disorder Using the Dissociative Disorders Interview Schedule (DDIS)

Background. It is important to understand the most diverse cultural aspects related to religiosity. Scientifically, it is important to understand religious manifestations and their relation to health, and to differentiate them from psychopathological manifestations. Objective. To evaluate the mental health of a group of mediums and compare it with that of a control group from the same religious context who do not manifest mediumship, using the Dissociative Disorders Interview Schedule (DDIS). Methods. This was a cross-sectional study, evaluating 47 mediums (Group 1) and comparing them with 22 non-medium volunteers from the same religious context (Group 2) using the DDIS questionnaire. All results were matched with historical data from patients with dissociative identity disorder (DID) who answered the DDIS. Results. Scores obtained from the DDIS were similar in both groups. The number of positive symptoms was comparable in a wide range of analyzed areas, involving but not being restricted to somatization disorder, major depressive episode, borderline personality disorder, extrasensory/paranormal experiences, physical/sexual abuse and five dissociative disorders. There were considerable differences when we compared these results with historical data from patients with DID. Conclusion. In agreement with the extant literature, these results showed that mediumship can be considered a non-pathological form of dissociative phenomena.     

Therapeutic Hazards of Treating Child Alters as Real Children in Dissociative Identity Disorder

ABSTRACT

Dissociative identity disorder (DID), with its typical etiology of extreme, repetitive childhood trauma, usually includes manifestations of childlike ego-states, among others. For many patients, these ego-states, originating with the initial traumatic insults to the psyche in childhood, have been called forth again and again as new situations evoke the earlier trauma. When clinicians, family and friends react to them with warmth, nurturing, and empathy, this may exacerbate the illusion that such ego-states are indeed actual children. This can result in a patient becoming increasingly resistant to working through the issues and experiences by which these ego-states have become fixed, with the risk of therapy reaching an impasse. Attitudes, interventions, and approaches to move past such impasses are addressed.     

EEG Coherence and Dissociative Identity Disorder

Abstract

This is the first study to apply EEG coherence analysis to the study of Dissociative Identity Disorder (DID). EEG coherence is argued to be an objective measure of cortical connectivity. Five DID patients were compared to five controls, who were professional actors. Fifteen dissociated DID alter states were studied, as were 15 “alters” simulated by the actor control participants. Comparisons of EEG coherence were made between DID participants and controls. Significant differences in EEG coherence were found in comparing DID host and alter personalities, with coherence found to be lower in the alter personalities. No significant differences were found in comparing DID host personalities and controls. The acted alters matched for age and gender, showed no significant differences in coherence compared to DID alter personalities. The results indicate that EEG coherence may be an objective measure of the neuronal cortical connectivity associated with DID.     

A prospective study of religion/spirituality and depressive symptoms among adolescent psychiatric patients

ObjectivePrevious research has uncovered relationships between religion/spirituality and depressive disorders. Proposed mechanisms through which religion may impact depression include decreased substance use and enhanced social support. Little investigation of these topics has occurred with adolescent psychiatric patients, among whom depression, substance use, and social dysfunction are common.Method145 subjects, aged 12–18, from two psychiatric outpatient clinics completed the Beck Depression Inventory-II (BDI-II), the Fetzer multidimensional survey of religion/spirituality, and inventories of substance abuse and perceived social support. Measures were completed again six months later. Longitudinal and cross-sectional relationships between depression and religion were examined, controlling for substance abuse and social support.ResultsOf thirteen religious/spiritual characteristics assessed, nine showed strong cross-sectional relationships to BDI-II score. When perceived social support and substance abuse were controlled for, forgiveness, negative religious support, loss of faith, and negative religious coping retained significant relationships to BDI-II. In longitudinal analyses, loss of faith predicted less improvement in depression scores over 6 months, controlling for depression at study entry.LimitationsSelf-report data, clinical sample.ConclusionsSeveral aspects of religiousness/spirituality appear to relate cross-sectionally to depressive symptoms in adolescent psychiatric patients. Findings suggest that perceived social support and substance abuse account for some of these correlations but do not explain relationships to negative religious coping, loss of faith, or forgiveness. Endorsing a loss of faith may be a marker of poor prognosis among depressed youth.     

Memory Fragmentation in Dissociative Identity Disorder

ABSTRACT

This study examined the quality of self-reported memories of traumatic experiences in participants with dissociative identity disorder (DID) and compared them with their memories of non-traumatic, but emotionally significant life experiences. Systematic interview data were gathered from 30 DID patients in The Netherlands. All participants reported a history of severe childhood abuse; 93.3% reported some period of amnesia for the index traumatic event, and 33.3% reported periods of amnesia for significant non-traumatic childhood experiences. All participants who had been amnestic for their trauma reported that their memories were initially retrieved in the form of somatosensory flashbacks. This suggests that, like PTSD patients, DID patients at least initially recall their trauma not as a narrative, but as somatosensory re-experiencing. Surprisingly, however, DID participants also recalled emotionally charged non-traumatic life events with significant somatosensory components, a phenomenon that has not been previously reported. This finding raises important issues regarding basic memory processing abnormalities in DID patients.     

The effectors responsible for gastrointestinal nematode parasites, Trichinella spiralis, expulsion in rats

Helper T (Th2) cells type 2 have a central role in host protective responses to gastrointestinal nematode parasite, Trichinella spiralis infection, but the actual effector mechanisms involved in parasite expulsion are still uncertain. Recent evidences suggest that mast cell recruitment and activation may associate with parasite elimination from host intestines in mice. On the other hand, IgE production may induce defensive responses to primary infection with the helminth in rats. The differences of host effector mechanisms to the same experimental infections might disturb our understanding of the host protective mechanisms to gastrointestinal nematode parasite infection. In order to redefine these differences, we investigated in detail the relationship between intestinal immune responses and worm expulsion following T. spiralis infection among several rat strains including mutants. As a result, there were significant correlations of parasite expulsion with mast cell hyperplasia in addition to serum IgE level. Moreover, mast cell-deficient and dysfunction rats showed delayed worm elimination from their gut. Therefore, the present study suggests that mast cells should also be one of the prominent effector cells involved in T. spiralis parasite expulsion in rats as well as mice.     

Israeli Mental Health Professionals' Attitudes Towards Dissociative Disorders,Reported Incidence and Alternative Diagnoses Considered

Abstract

Clinical diagnoses of dissociative disorders (DDs), including Dissociative Identity Disorder (DID), are controversial because there are mental health professionals in North America and elsewhere who are skeptical about whether these psychiatric disorders actually exist. This paper explores the attitudes of mental health professionals in Israel toward DDs and DID through a survey of 211 practicing clinicians (return rate of 39.5%). Of the sample, 95.5% scored at or above the point on a 5-point Likert scale measuring belief in the validity of DDs (m = 4.17, SD = 0.78); 84.5% declared at least a moderate belief in the validity of DID (M = 3.5, S.D. = 0.97). The average Israeli clinician surveyed had made 4.8 career-long DD diagnoses (S.D. = 18.06) and carried an average of 1.05 DD patients in his/her caseload (S.D. = 2.86). DID had a career-long diagnosis frequency of 0.14 patients per clinician (S.D. = 0.59) and was currently seen at a frequency of 0.03 cases per clinician (S.D. = 0.20). The five most frequently considered alternative diagnoses to DID in Israel were Borderline Personality Disorder (24%), Psychotic Disorder/Schizophrenia (23%), PTSD/Anxiety Disorder (10%), Malingering (8%) and Depressive Disorder (7%). The findings suggest that attitudes of Israeli clinicians are similar to those of North American clinicians despite the geographical and cultural differences between them.     

Patients’ perspectives on the role of radiation therapists

ObjectiveTo examine patients’ perspectives on the role of radiation therapists and to develop substantive theory about the relationships patients form with their radiation therapists.MethodsSemi-structured interviews were conducted with 34 breast cancer patients in Western Australia. Interviews were tape-recorded and transcribed verbatim. Grounded theory and the constant comparative method were used to analyse the data.ResultsThe major finding from this study was the importance that patients placed on achieving a sense of emotional comfort during their radiation therapy. Two ways in which patients achieved this comfort were by forming relationships with radiation therapists and gaining information related to their treatment and care.ConclusionRadiation therapists played a central role in enabling patients to achieve a sense of emotional comfort. Although radiation therapists have a technical job they need to remain aware of their role in providing patient care and take appropriate steps to ensure that they can assist patients in feeling comfortable during their radiation therapy.Practice implicationsThe role of the radiation therapist in assisting patients to achieve a sense of emotional comfort needs to be formalised to ensure that all patients in radiation therapy are aware of the radiation therapist's role and receive a similar level of care during treatment.     

Serological Diagnosis of Paracoccidioidomycosis through a Western Blot Technique

Paracoccidioidomycosis (PCM) is a serious infectious disease that progresses toward death if untreated. Its confirmatory diagnosis is made by the detection of the fungus Paracoccidioides brasiliensis in a direct mycological examination or by histopathology. However, these techniques are of low sensitivity. Serological tests seem to be more promising. The objective of this study was to test Western blot (WB) analysis using sera from patients suspected of PCM to determine whether it represents a safe and sensitive serological technique for a rapid and effective diagnosis for this disease. Sera from 517 patients were analyzed through WB analysis and double-immunodiffusion (DID) techniques using a crude exoantigen of P. brasiliensis 339. DID gave positive reactions for 140 sera (27%) and WB for 250 sera (48.4%). All sera that had a positive reaction by DID also had a positive result with a 43-kDa glycoprotein by WB analysis. Among the 377 samples that were negative by DID, 29.1% were reactive in WB analysis. For the cutoff dilution used (1:400), a positive reaction was not observed with any of the 102 sera from patients with other diseases in regions where such diseases are endemic and 30 healthy individuals tested as negative controls. These results prove WB analysis to be a sensitive technique and suggest its inclusion among routine laboratory assays as a safe method for PCM diagnosis.     

Hospital chaplains’ communication with patients: Characteristics,functions and potential benefits

ObjectiveHospital chaplains communicate with patients concerning spirituality/religion, but many aspects of their interactions have received little attention.MethodsTelephone qualitative interviews of ~1 h each were conducted with chaplains and analyzed, drawing on grounded theory.ResultsWe interviewed 21 U.S. chaplains. Chaplains have relatively unique characteristics, having relatively more time to spend with patients, and less rigid and less medicalized agendas, while gaining respect/trust as religious figures. Chaplains can thus provide several critical beneficial functions – e.g., obtaining key information from patients/families that can help with decision-making and with diagnosis and treatment, and conveying medical providers’ points of view to patients/families. Consequently, chaplains can serve as mediators between patients/families and providers; and also overcome staff biases and “labelling” of patients, and pursue or encourage psychological interventions, in part because psychotherapists are often unavailable.ConclusionWhile past research suggested certain ways how chaplains might benefit hospitals, these professionals can aid these institutions and improve patient care in additional vital, tangible ways.Practical implicationsHospital administrators, chaplaincy departments, doctors, nurses and others should more fully recognize, encourage and facilitate these functions. Targeted improvements in practice and education can help achieve these goals. The findings suggest, too, several specific questions for further investigation.     

Dissociation and Schizophrenia

Abstract

Comorbidity of psychotic and dissociative disorders often is not reported. This 38 year-old female with a history of schizophrenic symptoms displayed evidence of dissociative identity disorder (DID) during admission to an inpatient psychiatric unit. The case illustrates how the presence of a dissociative disorder may influence the presentation of a co-morbid psychosis. The historical association and differential diagnosis between DID and schizophrenia is described. Implications of various treatment approaches for patients exhibiting dissociation in the context of psychosis are discussed.     

Discriminating Dissociative Identity Disorder from Schizophrenia and Feigned Dissociation on Psychological Tests and Structured Interview

ABSTRACT

Objective: The purpose of this study was to evaluate the relative efficacy of a number of psychological tests and interviews in discriminating dissociative identity disorder (DID) from feigned dissociation and schizophrenia.

Method: Three measures of dissociation (SCID-D, DES, SDQ-5) two personality measures (MMPI-2, Millon-III) and a brief measure of hypnotic susceptibility (Spiegel & Spiegel's Eye-Roll Sign) were assessed for their ability to differentiate these diagnostic groups.

Results: Results indicate that the SCID-D was clearly the most efficacious instrument in discriminating DID from schizophrenia and from feigned dissociation. The DES-Taxon and the SDQ-5 were adequate in screening pathological dissociation from schizophrenia but were less discriminative of feigned dissociation. The commonly used personality inventories were unable to detect feigned dissociation and the DID group tended to have higher elevations on scales measuring psychotic symptoms than did the schizophrenic group. The Eye-Roll Sign discriminated feigned dissociation from those with dissociative disorders.

Conclusions: Structured interviews such as the SCID-D, although resource consuming, are essential in comprehensive assessment of dissociative disorders. Comprehensive assessment of psychotic disorders should include some measure of dissociation.     

Does Phasic Trauma Treatment Make Patients With Dissociative Identity Disorder Treatment More Dissociative?

Proponents of the iatrogenic model of the etiology of dissociative identity disorder (DID) have expressed concern that treatment focused on direct engagement and interaction with dissociated self-states harms DID patients. However, empirical data have shown that this type of DID treatment is beneficial. Analyzing data from the prospective Treatment of Patients With Dissociative Disorders (TOP DD) Study, we test empirically whether DID treatment is associated with clinically adverse manifestations of dissociated self-states: acting so differently that one feels like different people, hearing voices, and dissociative amnesia. We show that, over the course of the study, there were significant decreases in feeling like different people and hearing voices. These results indicate that this form of DID treatment does not lead to symptomatic worsening in these dimensions, as predicted by the iatrogenic model. Indeed, treatment provided by TOP DD therapists reduced, rather than increased, the extent to which patients experienced manifestations of pathological dissociation. Because severe symptomatology and impairment are associated with DID, iatrogenic harm may come from depriving DID patients of treatment that targets DID symptomatology.     

I will always be with you: Traditional and complementary therapists’ perspectives on patient–therapist–doctor communication regarding treatment of Arab patients with cancer in Israel

ObjectiveIn 2008, an Integrative Oncology Program was implemented at the Clalit Oncology Service in Haifa, Israel, to promote patients’ well-being during chemotherapy and advanced stages of disease. We hypothesized that studying the perceptions of Arab complementary and alternative medicine (CAM) therapists would facilitate development of a cross-culturally integrative oncology approach.MethodsSemi-structured interviews were held with 27 Arab therapists who use medicinal herbs, the Quran and various CAM modalities, with the aim of characterizing their treatment practices and learning about their perspectives regarding conventional cancer care.ResultsThematic analysis revealed that therapists act as go-betweens, mediating between patients and conventional physicians. Therapists translate diagnoses into Arabic and elucidate key concepts. They tend to perceive their role as gatekeepers accompanying patients through the conventional health system, referring them for further examinations, and providing CAM-based supportive care consultation.ConclusionsCAM therapists have an essential role in supportive care of Arab patients with cancer. Triangular patient–therapist–oncologist communication may have an impact on patients’ experience and treatment quality.Practice implicationsRecognition of CAM therapists as mediators between patients’ health beliefs and conventional perceptions of care may improve doctor–patient dialogue and facilitate supportive care provision in a cross-cultural context.     

Transient minimal hydronephrosis on contralateral kidney in infants with unilateral hydronephrosis: Is it an early sign of worsening of the affected kidney?

Background/aim The criteria for surgical management of ureteropelvic junction obstruction are not well-defined, and there is a risk for loss of renal function before the operation. In this context, certain changes in contralateral kidney had been investigated in order to increase the sensitivity of diagnosis. In this study, we aimed to investigate whether contralateral transient minimal hydronephrosis (CTMH) can be considered as an “early alarm” sign for worsening of the affected kidney in infants with hydronephrosis.Materials and methods A total of 182 infants (92 surgically treated and 90 conservatively followed-up) with unilateral hydronephrosis were retrospectively analyzed. Ultrasonography and renal scan findings were evaluated. Correlation between the appearance of CTMH, contralateral compensatory hypertrophy (CCH) on ultrasonography, and prognosis of the affected kidney were evaluated.ResultsAmong the surgically treated patients, 18 (19.6%) patients developed CTMH on average 7 months (0–13 months) before surgery. Among these 18 patients with CTMH, 12 patients (66.6%) had loss of renal function preoperatively, while this ratio was 29.7% on their counterparts (p = 0049). CCH was observed in 31 (33.7%) individuals in surgically treated patient group including all 18 patients with CTMH, while none of the conservatively followed-up patients developed CCH and/or CTMH. In the multiple logistic regression analysis, among the variables investigated, CTMH was found as an independent predictor of the deterioration in the affected kidney and of the poor prognosis (p = 0.011 and p = 0.0004, respectively).Conclusion In our study, among the variables investigated, CTMH was found as an independent predictor of the deterioration in the affected kidney and poor prognosis in infants followed-up with isolated unilateral hydronephrosis. Additionally, CTMH can be considered as an “early alarm” sign for worsening of the affected kidney and the need for surgical intervention.     

Comment on “Dissociation and Schizophrenia”

ABSTRCT

This paper suggests a tentative hypothesis to explain the apparent paucity of dissociative disorder patients between the 1920s and the 1970s: that the trance phenomenon that is now so characteristic in patients who struggle with childhood trauma may be a manner of handling emotional distress specific to certain periods in American history. The paper argues that trance is learnable; that there are specific periods in American history in which trance is encouraged in religious experience and that we are now in one such period; that in such periods, trance becomes incorporated into a complex behavioral practice in religious settings in which the boundary between the perceptually real and unreal may be blurred; and that the prevalence of this practice in religious settings may influence the symptom expression of those who struggle with the aftermath of trauma.