Dissociative Identity Disorder paper - comments?

[Orphia Nay]

I'd like some scientific analysis of a paper that purports to show that there is significant differences in brain activity between sufferers of Dissociative Identity Disorder (DID, formerly known as Multiple Personality Disorder) and people pretending to have different personalities.

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.

Link to the PLOS One study by Simone Reinders et al:

http://www.plosone.org/article/info:doi/10.1371/journal.pone.0039279

I'm a fan of science, but I'm not a scientist, and would like some educated analysis of a claim that seems rather extraordinary.

 

[truethat]

Well what are they comparing it to? The brain would operate in different ways even if the person didn't have DID (which I think is total BS btw) Did they compare it to say a normal kid that liked to play video games online where they create a sort of avatar character. Would not that kid have a different brain thing going on each time he played that game?

 

[GG Science]

A similar study from 2001, in Australia.

EEG coherence and dissociative Identity disorder: Comparing EEG coherence in DID hosts, alters, controls and acted alters

Authors: Annedore Hopper, Joseph Ciorciari, Gillian Johnson, John Spensley, Alex Sergejew, Con Stough.
School of Biophysical Sciences and Electrical Engineering and the Brain Sciences Institute, Swinburne University of Technology, Victoria, AUSTRALIE
Journal of trauma & dissociation, 2002, vol. 3, no1, pp. 75-88 (1 p.3/4)

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.

 

[Kevin_Lowe]

I would say that it doesn't show much.

Using professional actors as controls was a good idea, but it isn't necessarily the case that an actor playing a part will be doing the same thing as a "dissociative" bunging on an "alter". Professional actors have their body language, accent and so on under control for performance purposes but they aren't bunging on a version of themselves so they can act out with impunity.

It shows that something interesting is going on with these people's brains when they do their little play-act, but it says nothing about whether their condition is a form of acting out they've been coached in by unethical "therapists", as seems most likely to me, or whether it's a genuinely naturally arising mental condition.

 

[Orphia Nay]

A similar study from 2001, in Australia.

EEG coherence and dissociative Identity disorder: Comparing EEG coherence in DID hosts, alters, controls and acted alters

Authors: Annedore Hopper, Joseph Ciorciari, Gillian Johnson, John Spensley, Alex Sergejew, Con Stough.
School of Biophysical Sciences and Electrical Engineering and the Brain Sciences Institute, Swinburne University of Technology, Victoria, AUSTRALIE
Journal of trauma & dissociation, 2002, vol. 3, no1, pp. 75-88 (1 p.3/4)

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

I don't think that study means what you/they(?) think it means.

 

[Dancing David]

Considering the small sample size in the OP I do not think any conclusions can be drawn. I will look at the data again, but I sure don't see a significant effect outside the blood flow patterns.

And there is no discussion of past head trauma or other demographics that might lead to those results. Now one would expect some differences in people who are disassociative. But much of the discussion section is bogus , no data given on study sample sizes or effects.

 

[AlBell]

When did Multiple Personality Disorder be repaced by DID?

 

[GG Science]

Using professional actors as controls was a good idea, but it isn't necessarily the case that an actor playing a part will be doing the same thing as a "dissociative" bunging on an "alter".

Please define bunging in your usage here.

Yes, the point of the study was to attempt to show that, as you suggest in your second paragraph, people with DID aren't acting, or at least whatever is happening in their brains isn't the same as acting. The issue needs more study.

I don't think that study means what you/they(?) think it means.

Please elaborate, and what do you think it means, as a fan of science, of course.

 

[Orphia Nay]

Considering the small sample size in the OP I do not think any conclusions can be drawn. I will look at the data again, but I sure don't see a significant effect outside the blood flow patterns.

And there is no discussion of past head trauma or other demographics that might lead to those results. Now one would expect some differences in people who are disassociative. But much of the discussion section is bogus , no data given on study sample sizes or effects.

Thank you, DD. Much appreciated.

When did Multiple Personality Disorder be repaced by DID?

It was renamed DID with the publication of the DSM-IV. However, the ICD-10 still lists it as MPD.

 

[Orphia Nay]

Please elaborate, and what do you think it means, as a fan of science, of course.

(This is in relation to the study GG Science posted, which says:
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.)
==
EEG disadvantages include: "Signal-to-noise ratio is poor, so sophisticated data analysis and relatively large numbers of subjects are needed to extract useful information from EEG". There were 5 DID patients and 5 actors as controls. 10 is not a relatively large number.

"EEG determines neural activity that occurs below the upper layers of the brain (the cortex) poorly." The paper's conclusions were that the difference occurred in the cortex. They had no way of knowing if the "difference" was in lower regions of the brain.

I don't think the study means anything much, given the very low sample size. If it means anything, it means the alters are not real personalities, since there was no difference between them and the acted alters.

 

[Kevin_Lowe]

Please define bunging in your usage here.

They're acting out, according to a script handed to them by unethical and incompetent "therapists".

Yes, the point of the study was to attempt to show that, as you suggest in your second paragraph, people with DID aren't acting, or at least whatever is happening in their brains isn't the same as acting. The issue needs more study.

In my opinion no, it really doesn't.

While child sexual abuse is a terrible thing, it's highly likely that the modern First World is the time and place in which there is the least child sexual abuse in history.

Whereas MPD/DID was completely unknown until it experienced an explosion of claimed cases in the eighties, yet longitudinal studies of traumatised children totally failed to find that they came down with MPD/DID.

Where were all the MPD/DID cases in the Middle Ages, for example? Or anywhere in the world except affluent places in the eighties with access to therapists who were coaching people in how to bung on MPD/DID?

So it's demonstrably not caused by or correlated with child abuse, and it demonstrably is correlated with exposure to the idea that abuse victims should bung on MPD/DID symptoms for attention. Plus psychological studies have shown that while they sometimes lie about it, MPD/DID sufferers recall perfectly well what their "alters" saw, and presumably what they said and did.

Please elaborate, and what do you think it means, as a fan of science, of course.

My guess is that the mental state of "acting out" and faking psychiatric symptoms, perhaps combined with practice in doing so, produces a different mental state to that of a professional actor. I believe there's ample evidence that meditation can produce similar changes in detectable brain state so the brain is quite plastic enough for such effects to be detectable.

 

[Orphia Nay]

Thanks for your insightful comments, Kevin Lowe.

 

[Kevin_Lowe]

This seems to me a bit like the homeopaths leaping on any scientific study showing that, for example, there are large clusters of water molecules in liquid water, and taking it as evidence for their kooky belief.

The actual belief, that water's memory of random rubbish lasts through dilution past the point at which all trace of the rubbish has gone, and that the memory then can be magically transferred to a sugar pill, which can then magically transfer the memory to other sugar pills, which then magically cure whatever ailment the rubbish might have caused had you eaten enough of it, is so incredibly bizarre that nobody should believe it.

So instead of looking for evidence to directly support their real hypothesis they look for results that look like they might kinda-sorta-maybe relate to their pet hobby-horse and adopt them as evidence.

In this case we have evidence that what's going on in the brains of people bunging on MPD/DID symptoms isn't quite the same as what's going on in the heads of professional actors playing a part. It's being adopted as evidence that suddenly in the eighties child abuse started causing people to sprout totally independent personalities with their own firewalled set of memories, when that had never happened before in history, but only when pesky longitudinal studies weren't watching.

 

[ddt]

So it's demonstrably not caused by or correlated with child abuse, and it demonstrably is correlated with exposure to the idea that abuse victims should bung on MPD/DID symptoms for attention. Plus psychological studies have shown that while they sometimes lie about it, MPD/DID sufferers recall perfectly well what their "alters" saw, and presumably what they said and did.

E.g., Huntjens, Verschuere, McNally, "Inter-Identity Autobiographical Amnesia in Patients with Dissociative Identity Disorder".

 

[Orphia Nay]

E.g., Huntjens, Verschuere, McNally, "Inter-Identity Autobiographical Amnesia in Patients with Dissociative Identity Disorder".

Very interesting!

 

[Dancing David]

When did Multiple Personality Disorder be repaced by DID?

I think it was the DSM-IV, MPD was so incoherent and error prone it was discarded as not being conductive to diagnosis and statistics.

 

[Dancing David]

Now the question for me has to do with the incoherency and psychdynamic nature of the original MPD set, it was bogus. the people were never demonstrated to have alters in any way.

So at least DID tries to say something about behavioral states and presentation.

The problem I have comes from watching a clinician talk about 'she was her alter', when it could just have well been explained a panic attack.

Now are there people who have fugue states and other problem with memory, you bet there are.

Is there enough rule out on seizures, mood disorders and the like when it comes to the use of DID, no.

The problem comes about by the unethical use of the diagnosis, out of the five or so people who I met that had received the MPD diagnosis. 4 had active major substance abuse problems, all of them had a history closed head trauma.

My issue is that it should be viewed a tentative holding diagnosis and only used when all others have been ruled out.

 

[truethat]

I would say that it doesn't show much.

Using professional actors as controls was a good idea, but it isn't necessarily the case that an actor playing a part will be doing the same thing as a "dissociative" bunging on an "alter". Professional actors have their body language, accent and so on under control for performance purposes but they aren't bunging on a version of themselves so they can act out with impunity.

It shows that something interesting is going on with these people's brains when they do their little play-act, but it says nothing about whether their condition is a form of acting out they've been coached in by unethical "therapists", as seems most likely to me, or whether it's a genuinely naturally arising mental condition.

This is a good point, if a person who acts out in an identity, emotionally gets themselves into a sort of meditative trance to do so, I would say it would show up.

Instead of actors why not test people who meditate and compare them with DID.

 

[Kevin_Lowe]

This is a good point, if a person who acts out in an identity, emotionally gets themselves into a sort of meditative trance to do so, I would say it would show up.

Instead of actors why not test people who meditate and compare them with DID.

There seem likely to be major differences as well as similarities between what people meditating are doing and what MPD/DID people are doing. It was just an example to demonstrate that the plasticity of the human brain is sufficient to make such practiced states show up on EEGs.

 

[GG Science]

They're acting out, according to a script handed to them by unethical and incompetent "therapists".

Ah, neologisms are us apparently.

Citations, please, for this scenario wherein therapists inculcate their patients, with the mechanisms fully documented.

Whereas MPD/DID was completely unknown until it experienced an explosion of claimed cases in the eighties, yet longitudinal studies of traumatised children totally failed to find that they came down with MPD/DID.

Unknown? I think not, given that the foundation of psychiatry was at least partially built on its study, and there were famous cases a century and more before "Sybil".

1791 Eberhardt Gmelin

1812 Benjamin Rush

1816 Dr. Samuel Latham Mitchel
Mary reynolds

Justinus Kerner
"On the history of dissociative identity disorders in Germany: the doctor Justinus Kerner and the girl from Orlach, or possession as an "exchange of the self". The treatment of possession by animal magnetism and exorcism represents the special romantic-magnetic therapy of the German medical doctor Justinus Kerner in the early 19th century. This article describes the man, his methods, and his thinking and presents one of his most famous case studies, the girl from Orlach, which, by today's standards, was a true case of dissociative identity disorder (DID)."

1906 Morten Prince
Christine Beauchamp

Prospective studies of traumatized children show amnesia for the trauma. Linda Meyer Williams, 1994

Where were all the MPD/DID cases in the Middle Ages, for example? Or anywhere in the world except affluent places in the eighties with access to therapists who were coaching people in how to bung on MPD/DID?

Gee, where was western science in the middle ages?
Demon possession. Janus.
Maybe the authors of this book are in on some sort of conspiracy? Trauma And Dissociation in a Cross-cultural Perspective: Not Just a North American Phenomenon Describes studies and cases in Asia and the MIddle east.

Dissociative Symptoms and Reported Trauma Among Patients with Spirit Possession and Matched Healthy Controls in Uganda

So it's demonstrably not caused by or correlated with child abuse, and it demonstrably is correlated with exposure to the idea that abuse victims should bung on MPD/DID symptoms for attention. Plus psychological studies have shown that while they sometimes lie about it, MPD/DID sufferers recall perfectly well what their "alters" saw, and presumably what they said and did.

Surely you are aware that the vast majority of published, peer-review studies done on DID correlate it to childhood trauma, what theory do you have to account for this?