Transcript 12659586_UvA lezing 15-9-2014 MD-2.

Knowing me, knowing you:
Memory functioning in Dissociative Identity Disorder
Rafaële Huntjens
University of Groningen
Martin Dorahy
University of Christchurch
• Some people find that sometimes they are listening
to someone talk and they suddenly realize that they
did not hear all or part of what was said.
• Some people find that when they are watching
television or a movie they become so absorbed in the
story that they are unaware of other events
happening around them.
• Some people are told that they sometimes do not
recognize friends or family members.
• Some people have the experience of finding thenselves
dressed in clothes that they don’t remember putting on.
• Some people find that in one situation they may act so
differently compared with another situation that they
feel almost as if they were different people.
Symptom level (Steinberg, 1995)
• depersonalisation
• derealization
• identity confusion
• amnesia
• identity alteration
Dissociative amnesia (DSM-5)
• Recurrent gaps in the recall of everyday events,
important personal information, and/or traumatic
events that are inconsistent with ordinary forgetting.
Do I know you?
Autobiographical memory functioning in dissociative identity disorder
Case example dissociative amnesia
https://www.youtube.com/watch?feature=player_detailpage&
v=B0LNyXsErb8#t=303
Inter-identity amnesia in DID:
Neutral information
Inter-identity amnesia in DID
neutral information
• recall list A
vegetables (eg pepper)
animals (eg caterpillar)
flowers (eg rose)
• recall list B (amnesic identity)
vegetables (eg pea)
animals (eg camel)
furniture (eg couch)
Huntjens, R. J. C., Postma, A., Peters, M., Woertman, L., & Van der Hart, O. (2003).
Interidentity amnesia for neutral, episodic information in dissociative identity
disorder. Journal of Abnormal Psychology, 112, 290-297.
Mean recall score Trial 1
7
6
5
controls, shared
controls, unshared
4
3
2
List A
List B
Mean recall score Trial 1
8
7
controls, shared
6
controls, unshared
5
4
simulators, shared
3
simulators,
unshared
2
1
0
List A
List B
Mean recall score Trial 1
8
controls, shared
7
controls, unshared
6
5
simulators, shared
4
3
simulators,
unshared
2
DID patients,
shared
1
DID patients,
unshared
0
List A
List B
Inter-identity amnesia in DID
trauma-related information
List A:
• trauma-related
• “abuse”
• Positive words
• music””
• Neutral words
• “page”
List B (amnesic identity):
• trauma-related
• “pain”
• Positive words
• “blossom”
• Neutral words
• “cloud”
Huntjens, R. J. C., Peters, M., Woertman, L., & Van der Hart, O., & Postma, A. (2007). Memory
transfer for emotionally valenced words betrween identities in dissociative identity disorder.
Behaviour Research and Therapy, 45, 775-789.
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Inter-identity amnesia in DID:
Autobiographical information
Figure 1. Mean reaction time for same identity, other
identity, and irrelevant items for DID patients, control
participants, and simulators.
Huntjens, R. J. C., Verschuere, B., & McNally, R.J. (2012).
Inter-identity autobiographical amnersia in patients with dissociative identity disorder. PLoS ONE, 7, e40580.
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Allen, J. J. B., & Movius, H. L.,II. (2000). The objective assessment of amnesia in dissociative identity disorder using eventrelated potentials. International Journal of Psychophysiology, 38(1), 21-41. doi: 10.1016/S0167-8760(00)00128-8
Eich, E., Macaulay, D., Loewenstein, R. J., & Dihle, P. H. (1997). Implicit memory, interpersonality amnesia, and dissociative
identity disorder: Comparing patients with simulators. In J. D. Read, & D. S. Lindsay (Eds.), (pp. 469-474). New York, NY US:
Plenum Press.
Huntjens, R. J. C., Peters, M. L., Postma, A., Woertman, L., Effting, M., & Hart, O. van der (2005). Transfer of newly acquired
stimulus valence between identities in dissociative identity disorder (DID). Behaviour Research and Therapy, 43(2), 243-255.
doi: 10.1016/j.brat.2004.01.007
Huntjens, R. J. C., Peters, M. L., Woertman, L., Bovenschen, L. M., Martin, R. C., & Postma, A. (2006). Inter-identity amnesia in
dissociative identity disorder: A simulated memory impairment? Psychological Medicine, 36(6), 857-863. doi:
10.1017/S0033291706007100
Huntjens, R. J. C., Peters, M. L., Woertman, L., Hart, O. van der, & Postma, A. (2007). Memory transfer for emotionally
valenced words between identities in dissociative identity disorder. Behaviour Research and Therapy, 45(4), 775-789. doi:
10.1016/j.brat.2006.07.001
Huntjens, R. J. C., Postma, A., Hamaker, E. L., Woertman, L., Van, D. H., & Peters, M. (2002). Perceptual and conceptual
priming in patients with dissociative identity disorder. Memory & Cognition, 30(7), 1033-1043. doi: 10.3758/BF03194321
Huntjens, R. J. C., Postma, A., Peters, M. L., Woertman, L., & van, d. H. (2003). Interidentity amnesia for neutral, episodic
information in dissociative identity disorder. Journal of Abnormal Psychology, 112(2), 290-297. doi: 10.1037/0021843X.112.2.290
Huntjens, R. J. C., Postma, A., Woertman, L., Hart, O. van der, & Peters, M. L. (2005). Procedural memory in dissociative
identity disorder: When can inter-identity amnesia be truly established? Consciousness and Cognition: An International
Journal, 14(2), 377-389. doi: 10.1016/j.concog.2004.10.001
Huntjens, R. J. C., Verschuere, B., & McNally, R. J. (2012). Autobiographical amnesia in patients with dissociative identity
disorder. PLoS ONE, 7, e40580.
Kong, L. L., Allen, J. J. B., & Glisky, E. L. (2008). Interidentity memory transfer in dissociative identity disorder. Journal of
Abnormal Psychology, 117(3), 686-692. doi: 10.1037/0021-843X.117.3.686
Silberman, E. K. (1985). Dissociative states in multiple personality disorder: A quantitative study. Psychiatry Research, 15(4),
253-260. doi: 10.1016/0165-1781(85)90062-9
Dissociative meta-memory beliefs
(Huntjens & Dorahy, in prep)
 Fragmentation
 “I believe I can remember distressing events in parts, but not as a whole”
 Fear of retrieval of negative events
 “I believe thinking about past negative experiences will hurt me
emotionally”
 Lack of self-reference / lack of acknowledgement
 “I believe some of the memories that come into my mind about my past
don’t belong to me”
Differential identity functioning:
Autobiographical memory specificity
Huntjens, R. J. C., Wessel, I., Hermans, D., & Van Minnen, A. Autobiographical Memory Specificity and
Avoidance in Dissociative Identity Disorder. Journal of Abnormal Psychology, 123, 419-428.
 Autobiographical Memory Task (AMT; Williams & Broadbent, 1986)
HAPPY
Answers healthy controls:
 “The birth of my first child”
 “My last birthday” party”
Answers PTSD patients / depressive patients:
 “I am never happy”
 “In the summer of ‘76 when I stayed with my
grandparents”
 “Always when I was in my safe place up in the apple
tree”
Two types of identity states:
• Trauma identity state
• Amnesic identity state
Hypothesis:
• Fewer specific memories in the amnesic identity state
Number of specific memories
t(11) = .42, p = .68, η2 = .02
Number of specific memories
F(2, 62) = 5.18, p = .008, partial η2 = .14
DID vs. Controls: p = .037
PTSD vs. Controls, p = .004
PTSD vs. DID, p = .99
Summary
• Both DID and PTSD patients scored higher on self-reported
avoidance.
• In DID, the trauma and amnesic identities did not differ on memory
specificity.
• Independent of identity, the DID patients as well as the PTSD
patients scored lower on memory specificity compared to controls.
• Detrimental impact on daily life functioning: problem solving, mood
repair
Differential identity functioning:
Self-defining memories and future goals
Self-defining memories
•Targeted to elicit important personal memories
•Exemplar autobiographical memories that
reflect one’s identity
•Affectively intense, repetitive, vivid
Personal goals
•Things most important for the participant to
achieve in the future (trying to attain or seeking
to avoid or prevent)
Rater trauma-relatedness (SDM)
z = 2.38, p = .02, r = .51
Self-reported trauma-relatedness (SDM)
t(10) = 1.72, p = .12, η2 = .23
Self-reported trauma-relatedness (SDM)
F(2, 66) = 37.78 p < .001, η2 = .53
DID vs. Controls: p = .001
PTSD vs. Controls, p < .001
PTSD vs. DID, p = .75
Self-reported trauma-relatedness (goals)
t(10) = .86, p = .41, η2 = .07
Self-reported trauma-relatedness (goals)
Chi2(2) = 47.66 p < .001, η2 = .69
DID vs. Controls: p < .001
PTSD vs. Controls, p < .001
PTSD vs. DID, p = .74
Proportion avoidance goals
Chi2(2) = 9.40 p = .009, η2 = .14
DID vs. Controls: p = .13
PTSD vs. Controls, p = .44
PTSD vs. DID, p = .007
Summary and conclusion
• Trauma identity focus on retrieval of traumatic
events as SDM
• Amnesic identity not focused on trauma-unrelated
daily life but focused on (dealing with)consequences
of trauma (running away, substance abuse, therapy,
not finishing high school, auto-mutilation)
• Both identities more avoidant goals compared to
PTSD
General Conclusion
• No empirical evidence for memory compartmentalization
• Similarities between PTSD and DID in memory functioning
(overgeneral memory, SDM memories)
• Joint diagnostic category of (complex) posttraumatic disorders?
• Impaired meta-cognition as the cause of self-reported amnesia?
Future research:
• Transdiagnostic research of functioning in trauma-related
disorders (i.e., including samples of borderline, (complex) PTSD,
and other trauma-related disorders
• Treatment innovations
Schema Therapy as a viable alternative
for the treatment of DID?
Schema Therapy as a viable alternative?
• emphasis on dealing with early childhood abuse
and neglect
• severe attachment problems, minimal coping
capacity, and severe personality pathology are
explicitly addressed
• given lack of evidence for compartmentalisation,
the definition of modes relates very well to identity
states in DID:
• The specific emotions, cognitions & behaviors that are
currently activated
Adapted protocol ST DID
• lenght of treatment: 3 years
• define identities in mode terms
• emphasis on functional groups of modes
instead of individual identities
• subjective experience of switching between
identities is acknowledged and explained by
shifts between modes
• after thorough mode conceptualization,
further ST goals and interventions are readily
applicable to DID
Switch to my male alter:
Martin Dorahy
Episodic autobiographical memory
transfer across subjectively
experienced amnesic identities
Present Study Objectives
• To assess episodic autobiographical memory in dissociative
identity disorder (DID), with regard to transfer of episodic
autobiographical information across identities that report
having no awareness of each other (two-way amnesia).
• To assess autobiographical memory differences across
groups with DID, non-clinical controls, and people
simulating DID.
• To assess how the emotional content of a memory
influences retrieval in the identity that experienced the
event and the identity that did not experience the event
(specifically, the emotion of embarrassment).
Participants
• Participants
– 20 DID (currently 18, but some unuseable)
– 40 Controls (20 amnesic, 20 non-amnesic) (currently 32, one ?DD)
– 20 DID Simulators (currently 12)
• Recruitment
– DID via Belmont Private Hospital and private practices in Christchurch
– Controls via University of Canterbury participant pool, ‘Subjects Wanted’
website, leaflets in Psychology Department, public libaries. churches
– DID Simulators via Drama department at University of Canterbury and
contacts in Brisbane
• Simulator training
– Independent of testing session
– Information sheets, videos, working with research assistant
• Researcher blind to DID and simulators
• DID/Simulators asked to chose two identities, one aware of painful life
events, one unaware of them.
Experimental Task 1
• Presentation of narratives (through head phones):
– Embarrassing & neutral – identity A
Counterbalanced
– Embarrassing & neutral – identity B
– Second person (‘You’) to first person (‘I’) transformation
when repeating (autobio, internalised)
Embarrassment script
Control script
Memory measurement
• Assessed immediately (FR), and aIAT.
• Then approximately 45 minutes after
exposure:
• Memory assessment:
– free recall,
– force-choice recognition; know and remember
judgments,
Free-recall – Tested in identity A
• First question: For this task, I would like you to tell me everything you can
remember about the stories you heard through the headphones. Start with the
first story, do you remember it? Can you tell me what you remember? ? [If no, Do
you remember hearing a story about…[PUT HERE THE SHAME/NEUTRAL STORY
THEY DID HEAR , EG., A SUPERMARKET TRIP; A TRIP TO THE BANK]
– 2 minutes space to narrate the story
•
Probe: Are those all the details you have about those stories? (Similar to probe used by
Berryhill et al., 2007).
• Second question: Now I would like you to tell me anything you can about the
second story. do you remember it? Can you tell me what you remember.
–
2 minutes space to narrate the story
• Probe: Are those all the details you have about those stories?
• ‘Do you remember hearing any other stories’. Do you remember a story about…
Force-choice recognition
Remember/Know
• Remember judgments: If your recognition of
the sentence is accompanied by a conscious
recollection of its prior occurrence in what you
saw, heard or did earlier, then press “R.”
(episodic)
• Know judgments:, press “K” (for “know”)
when you are certain of recognizing the
sentence but the sentence fails to evoke any
specific recollection of the event. (semantic)
Autobiographical Implicit Association
Test (aIAT)
• An implicit (non-conscious) assessment of
whether an autobiographical memory has been
encoded
• This will allow us to see if the experience of one
identity (ie., the stories they were presented)
impact at a non-conscious level on the
information retrieved by the other identity.
• Thus, it assesses non-conscious
interference/influence
Experimental Task 2
• Event creation:
– engaging in highly specific and novel tasks during
study
– Each task has some reference to the person
themselves to create a more autobiographical and
personalised experience
Eg., Identity A Experiences:
• First, I would like you to take your mobile phone out, put it on silent
and place it next to the pot plant.
• Second, I would like you to retrieve that book from the table, which
is under some papers. Turn to page __ and study the photo of the
three shapes [circle, triangle and square].
• Now, following the instructions beside the picture, I would like you
to draw the shapes. Then colour the circle in blue, the triangle in
red and the square in green.
• Now, using your favourite coloured pen, write your name on the
circle and your birthday on the square.
• Now, what memory associated with your life comes to mind when
you see the finished picture? When you have one, I would like you
to spend twenty seconds visualizing this memory.
Identity B Script
• First, trace a picture of a dog using the blue pen
• Second, fill those three cups with water to the level
marked on the side of each cup. Then, place them in
order from least amount of water to highest.
• Now, I would like you to create an origami model of a
finger pointer. Follow these instructions.
• Now, I would like you to view these photos of people
and identify them while pointing with the origami
finger
• Now could you rank them from your most to least liked
• Finally, I would like you to state which person you see
as being most similar to you. Could you provide a
reason for your decision?
Memory measurement
• Assessed approximately 45 minutes after
exposure
• Memory assessment
– free recall
– force-choice recognition
Thank you!
[email protected]