Schema therapy for Dissociative Identity Disorder:a case report

Treatment for Dissociative Identity Disorder (DID) often follows a practice-based psychodynamic psychotherapy approach that is conducted in three phases: symptom stabilization, trauma processing, and identity integration and rehabilitation. The percentage of patients that reach the third phase is relatively low, treatment duration is long, and the effects of this treatment on the core DID symptoms have been found to be small or absent, leaving room for improvement in the treatment of DID. Schema Therapy (ST) is an integrative psychotherapy that has been proposed as a treatment for DID. This approach is currently being investigated in several studies and has the potential to become an evidence-based treatment for DID. This case report presents an overview of the protocol adaptations for DID ST treatment. The presented case concerns a 43-year-old female patient with DID, depressive disorder (recurrent type), PTSD, cannabis use disorder, and BPD. Functioning was very low. She received 220 sessions of ST, which included direct trauma processing through Imagery Rescripting (ImRs). The patient improved in several domains: she experienced a reduction of PTSD symptoms, as well as dissociative symptoms, there were structural changes in the beliefs about the self, and loss of suicidal behaviors. After treatment she was able to stop her punitive mode, to express her feelings and needs to others, and to participate adequately in social interaction. This case report indicates that ST might be a viable treatment for DID, adding to a broader scope of treatment options for this patient group.</p

Dissociation and Dissociative Identity Disorder (DID)

Dissociative experiences are thought to occur acutely (e.g., during or immediately following trauma) or chronically and are considered to reduce the subjective distress accompanying stressful events. Growing evidence is consistent with a model that distinguishes between two qualitatively different types of phenomena—“compartmentalization” and “detachment.” Compartmentalization involves a deficit in the ability to deliberately control processes or actions that would normally be amendable to such control (e.g., amnesia and dissociative identities). Detachment refers to an experienced state of disconnection from the self or the environment (e.g., depersonalization, derealization, and numbing).In the present contribution, we discuss both detachment and compartmentalization phenomena. In addition, we discuss both dissociation as an acute response to trauma and persistent dissociation in the form of the most severe and chronic of the dissociative disorders, dissociative identity disorder (DID). We attend to the burgeoning empirical literature on memory processing and dissociation given the central role of these cognitive operations in the development and maintenance of the dissociative disorders, and more broadly, posttraumatic symptomatology.We end with a more general appeal for more transdiagnostic studies of dissociative phenomena, both in the areas of detachment and compartmentalization, emphasizing that dissociative disorders are not a category of mysterious diagnoses that need to be understood outside of well‐known cognitive operations.<br/

Manipulating age in earliest memories

We examined the malleability of the estimated age in undergraduates’ earliest memories. In study 1, vignettes containing examples about age 2 rendered earlier ages than examples referring to age 6. Study 2 showed that eliciting self-relevant or public event knowledge from participants’ preschool years prior to retrieval rendered similar average ages, which were earlier than in memories retrieved after a no-age control task. In addition, the results of both studies fuel speculations that age estimates vary across memory types (earlier snapshots versus later narratives) and suggest that narratives might be more sensitive to age manipulations than snapshots. Taken together, the results add to the growing literature indicating that the average age in first memories is more flexible than previously thought

The Dissociation-Related Beliefs About Memory Questionnaire (DBMQ):Development and Psychometric Properties

Objective: Discontinuities in memory are the hallmark symptoms of most dissociative disorders but are also reported by patients diagnosed with related disorders, including PTSD. Memory discontinuity is most evident in dissociative identity disorder (DID), where patients may report amnesia in 1 identity for information available in other identities (i.e., interidentity amnesia). Studies indicate that even though patients subjectively report interidentity amnesia for material learned in, or pertaining to, another identity, objective findings show evidence of transfer of that material between identities. Subjective reports of dissociative amnesia may be explained by specific dissociation-related metamemory beliefs, which hinder voluntary retrieval, personal acknowledgment, and processing of memories. This study aimed to develop a questionnaire indexing metamemory beliefs related to trait dissociation. Method: Two studies in nonclinical populations provided information about the factor structure (Studies 1 and 2) of the newly developed Dissociation-related Beliefs about Memory Questionnaire (DBMQ). Information was also provided about the construct validity (Studies 2 and 3), and reliability of the scale (all 3 studies) in nonclinical as well as a clinical population. Results: Results indicated sound psychometric properties of a short 16-item DBMQ with subscales assessing Fragmentation, Positive beliefs about amnesia, Lack of self-reference, and Fear of losing control, and correlations specifically with trait dissociation and posttraumatic avoidance symptoms. A sample of DID patients (N = 19) showed increased scores on the DBMQ. Conclusion: The DBMQ provides a short, reliable, and valid tool for indexing dissociation-related metamemory beliefs. These beliefs were associated with trait dissociation and posttraumatic avoidance symptoms

The Tonic Immobility Scale in adolescent and young adult rape victims:Support for three-factor model

OBJECTIVE: A substantial number of sexual assault victims report experiencing some form of peritraumatic tonic immobility (TI). A self-report questionnaire that is widely used to assess TI retrospectively is the Tonic Immobility Scale (TIS). This study explored the factor structure of the TIS in a clinical sample of adolescent and young adults. METHOD: The sample comprised 131 female rape victims, aged 13-25, who were referred for specialized trauma-focused treatment. An exploratory factor analysis (EFA) was performed. RESULTS: The EFA showed support for a three-factor model, with factors TI, Fear, and Detachment. Item correlations ranged from .32 to .57 for TI, from .14 to .35 for Fear, and .29 for the two Detachment items. CONCLUSIONS: We found support for a three-factor solution distinguishing TI, fear, and detachment, suggesting the need to further develop the TIS with different subscales in varying age groups and clinical samples. (PsycInfo Database Record (c) 2021 APA, all rights reserved)