minds-bethany-brand 2013This week, we get to hear from Bethany Brand, Ph.D., internationally recognized expert in trauma and dissociative disorders, including Dissociative Identity Disorder. Part I is here…

S: Why the controversy and stigma with Dissociative Identity Disorder?
B: When I was at my internship at George Washington University we had a patient who said she had DID—it was MPD back then—and I was very skeptical. I have to admit I doubted the reality of DID. I got an impromptu consultation from Judy Armstrong at Shepard Pratt about the patient’s psychological testing results who worked with the Trauma Disorders Unit. She said that the patient showed a number of features common in the test results of DID patients. That was one of the early influences that made me more open minded about the disorder. Many clinicians become more open minded when they learn about dissociation and how to assess for it, then meet a client who has severe dissociation. It doesn’t look the stereotyped way Hollywood portrays it.

It becomes obvious how much these individuals suffer from many symptoms including dissociation. Most of them don’t want to have DID and are not suggestible the way the writers who have fueled the controversy have alleged. The critics argue that people can’t forget memories of trauma, and that previously dissociated memories are not likely to be accurate recollections, but that is just not supported by most research. For example, a recent review of research concluded that only a tiny fraction of dissociation is due to suggestibility and that there are studies that have found corroborating evidence that people with DID have experienced severe abuse.

S: I totally get that there are features that make DID hard to understand, and maybe hard to believe. As opposed to other disorders that have a serious overall impact on functioning, like schizophrenia, people with DID can sometimes present as really well and then have parts of the day where they are totally dysfunctional.
Also, most people diagnoses with DID are women. In our culture when a woman says she is ill, that is perceived as being weak or attention-seeking.
B: Right. When women say that they have DID, it can seem like they’re not taking responsibility for their behavior. As a society we doubt it when anybody says they don’t remember some of their behavior because it seems like they’re trying to get out of taking responsibility for what they’ve done.
And it sounds far-fetched. It’s part of the misunderstanding of what DID is: many people mistakenly think DID means someone has different people inside of them. However, no one in the dissociative disorders field thinks there are different people inside of someone with DID.
There are different emotional states that they get into that have relative discontinuous patterns of thinking, feeling, perceiving, and memories. Research shows there are different neural networks being activated by different states. Some are more emotionally driven, others less so, and when they shift into different states, the areas of the brain related to emotions and internal awareness become activated or not.

S: I find the idea of emotional parts much easier to empathize with. I’m a fan of Internal Family Systems, which talks about the fact that we ALL have emotional parts. I know on my daily commute, some days I feel very kind and generous toward the tourists on the metro and other days I feel like everyone is in my way and that this is different emotional parts of me responding to the same stimuli.
B: Right, exactly.

S: I think one of the hardest things for people to understand is the idea of Apparently Normal Parts. What is a good way to conceptualize those?
B: Remember how you thought when you were a child, you thought in black and white, absolute ways. Child states in DID are often the most traumatized, fearful, depressive parts. If you think about state dependent learning, when in these states, they can access the more painful memories of trauma. If you have a bad day, you might think about everything that’s bad in your life, but you get a good night’s sleep and in the morning you have a different perspective. However, if a person has DID and has amnesia for certain dissociated self-states, they may have an amnestic gap for what they thought and did in a different state. This amnesia makes the difference between DID states more drastic and upsetting that what happens to non-DID people.
And now there are fMRI scanning studies showing that the emotional parts have very different brain activity compared to the non-emotional parts. Actors weren’t able to fake these activation patterns. There are other physiological studies showing that people have different physiological characteristics when in different states.

S: Okay, so the amnestic barrier prevents integrating new information in with the old information.
B: Exactly. They’re not integrating their past traumas, not developing a more organized view of other people and of themselves. Different schemas are being held simultaneously. We all hold schemas throughout life, but for people who have experienced profound trauma, some of their schemas may not shift or mature. While in child-like states, they may still think “I’m all bad” until the traumas that made them feel they are bad havebeen resolved.

S: What is something about dissociation that you wish that everyone knew?
B: That it is much more common than recognized and it is very treatable.

For those interested in reading more about dissociative disorders and DID, here are some peer-reviewed journal articles that discuss topics from the interview:
Brand, B.L., Loewenstein, R.J., & Spiegel, D. (2014). Dispelling Myths about Dissociative Identity Disorder Treatment: An Empirically Based Approach. Psychiatry: Interpersonal and Biological Processes, 77(2), 169-189.

Dalenberg, C. J., Brand, B. L., Loewenstein, R. J., Gleaves, D. H., Dorahy, M. J., Cardeña, E. B., Frewen, P. A., Carlson, E. B., Spiegel, D. (2014). Reality versus fantasy: Reply to Lynn et al. (2014). Psychological Bulletin, 140, 911-920.

Dalenberg, C. J., Brand, B. L., Gleaves, D. H., Dorahy, M. J., Loewenstein, R. J., Cardeña, E., & … Spiegel, D. (2012). Evaluation of the evidence for the trauma and fantasy models of dissociation. Psychological Bulletin, 138(3), 550-588. doi:10.1037/a0027447

Dorahy, M.J., Brand, B.L., Krüger, C., Lewis-Fernández, R., Martínez-Taboas, A., & Sar, V., Middleton, M., Stavropoulos, P. (2014). Dissociative Identity Disorder: An empirical review. The Australian and New Zealand Journal of Psychiatry, 48(5), 402 – 417.

Reinders, A. S., Willemsen, A. M., den Boer, J. A., Vos, H. J., Veltman, D. J., & Loewenstein, R. J. (2014). Opposite brain emotion-regulation patterns in identity states of dissociative identity disorder: A pet study and neurobiological model. Psychiatry Research: Neuroimaging, doi:10.1016/j.pscychresns.2014.05.005

Reinders, A., Nijenhuis, E. S., Quak, J., Korf, J., Haaksma, J., Paans, A. J., & … den Boer, J. A. (2006). Psychobiological Characteristics of Dissociative Identity Disorder: A Symptom Provocation Study. Biological Psychiatry, 60(7), 730-740. doi:10.1016/j.biopsych.2005.12.019