What symptoms would family members see in a person had dissociative identity disorder? You may notice sudden changes in mood and behavior. People with dissociative identity disorder may forget or deny saying or doing things that family members witnessed. The person may go from being fearful, dependent and excessively apologetic to being angry and domineering.
He or she may report not remembering something they said or did just minutes earlier. Be open and accepting in your responses. Rather view them as portions of the person as a whole. We are all different in different situations, but we see this as different sides of ourselves.
Try to maintain that perspective with the person with dissociative disorder. Hattie Gladwell is a mental health journalist, author, and advocate. She writes about mental illness in hopes of diminishing the stigma and to encourage others to speak out. Do you know the difference between borderline personality disorder and bipolar disorder? Borderline personality disorder and relationships can be a complicated mix. Being aware of the impact of BPD, seeking professional help, and offering…. Fear of abandonment can have a negative impact on your relationships.
But it is possible to treat it with lifestyle changes. Here's what you need to…. I know caring for someone with BPD can be confusing and hard. But with a better understanding of the condition and its implications it can be easier.
Previous studies used functional magnetic resonance imaging fMRI during symptom provocation tasks or during resting state to investigate brain activity in BPD patients with high dissociation. Findings of these studies most consistently pointed to increased activity in frontal areas inferior and middle frontal gyrus, superior frontal regions and reduced activation in temporal areas inferior and superior temporal gyrus during symptom provocation and rest.
Some studies also found lower activity in the amygdala during presentation of aversive pictures in patients who reported higher dissociation. However, findings are diverse and some studies did not find significant links between altered task-related or resting-state brain activity and dissociation for a more detailed description see [ 3 ] and Table 1. To our knowledge, so far, only three neuroimaging studies in BPD investigated the effect of experimentally induced acute dissociation on neural processing, using a script-driven imagery paradigm [ 66 , 75 , ].
In this paradigm, patients create a narrative of a personal situation in which dissociative experiences occurred. Across three different studies, this experimental paradigm led to a significant increase in self-reported dissociation [ 66 , 75 , ].
Patients who listened to a dissociation script also reported lower pain sensitivity [ ], confirming earlier findings [ 47 ]. Two of these studies combined script-driven imagery with neuropsychological tasks measuring emotional interference inhibition, i. During the EST, patients who had been exposed to a dissociation script showed impaired task performance overall slower and less accurate responses , impaired interference inhibition for negative versus neutral words, and altered activity in regions implicated in interference inhibition fusiform gyrus, left inferior frontal gyrus, parietal cortices [ 75 ].
More recently, Krause-Utz et al. Patients who listened to a dissociation script later showed impairments in working memory after distraction by social information pictures of interpersonal violence versus neutral interpersonal scenes and in distractor-free trials [ 66 ]. On the neural level, patients with acute dissociation showed increased activity in the inferior frontal gyrus, which is consistent with the other two script-driven imagery studies [ 75 , ].
In addition, patients who performed the EWMT after listening to the dissociation script showed reduced amygdala activity and reduced left cuneus, lingual gyrus, and posterior cingulate activity [ 66 ]. The complexity of dissociative symptoms and the broad range of functions that they affect render it unlikely that effects can be traced down to a few localized brain regions.
Several studies used functional connectivity analysis to investigate dynamic interactions between brain regions within large-scale brain networks. In another study [ ], acute dissociation was linked to a stronger coupling of the amygdala with the insula, ACC, and thalamus during the presentation of aversive distractors.
In another study, dissociation increased after scanning, but these changes did not predict changes in amygdala RSFC after an emotion regulation task [ ]. Differences in sample characteristics e. Patients with BPD and healthy controls were exposed to highly aversive pictures mixed with neutral pictures. Both groups showed a significant shift from left- to right-sided asymmetry during the experiment, which suggests effortful emotion regulation.
Interestingly, frontal electroencephalographic asymmetry at baseline was significantly correlated to childhood trauma severity and dissociative tendencies DES in the BPD group.
In the context of earlier neuroimaging findings, these results provide preliminary evidence for a link between dissociation conversion symptoms and emotion regulation. However, more studies are needed to replicate these findings before firm conclusions can be drawn. In a similar vein, only a few BPD studies investigated associations between dissociation and altered brain structure.
Two studies found preliminary evidence for larger volumes of the right precuneus and left postcentral gyrus [ ] and larger gray matter volumes in the middle and superior temporal gyrus [ ]. More research is needed to understand if dissociation is associated with altered brain structure in BPD. So far, the most consistent findings seem to be an increase in frontal activity e. Altered activity in the inferior and middle frontal gyrus and superior frontal regions was also observed in D-PTSD [ 97 ], DID [ 99 , ], conversion disorder [ ], and depersonalization [ 86 ].
Whether certain alterations e. A more specific assessment of dissociation and a careful assessment of potentially confounding variables e. Since research on dissociation in BPD is scarce, we broadened the scope of our current review, including studies that used other experimental approaches psychophysiological measures, pain processing, body perception to study dissociation.
While these studies deviate from the main focus of our previous review neuroimaging studies [ 3 ], they might offer important input for future neuroimaging research on dissociation in BPD. The aforementioned corticolimbic-disconnection model [ 86 ] proposes that increased prefrontal modulation of amygdala activity is associated with dampened autonomic arousal, which may show in reduced startle response [ 73 , ].
The defense cascade model by Schauer and Elbert [ 23 ] proposes a sequence of fear responses that escalate as a function of proximity of threat. Increased parasympathetic activity during dissociation has also been linked to a drop in heart rate [ 17 , ].
In BPD specifically, previous studies found reduced startle response while listening to startling tones [ 73 ] and stressful scripts [ ]. It has been proposed that low autonomic arousal may reflect an interfering effect of dissociation on emotional processing in BPD [ ]. Patients with BPD who reported high acute dissociation also showed diminished SCR during a fear conditioning paradigm [ 74 ] and stressful scripts [ ].
Patients with high PD showed a significant heart rate decline during the imagery of personal traumatic events compared to the two other groups, while no differences in SCR were found. Increases in trauma-evoked heart rate were predicted by peritraumatic dissociation but not by measures of state or trait dissociation. However, sample sizes were quite small, patients had a history of childhood trauma, and some patients met criteria for PTSD or dissociative disorder see Table 1.
Participants were instructed to either attend or downregulate emotional responses to neutral, positive, and negative images. Acute dissociation before the task positively predicted HF-HRV during downregulating versus attending negative pictures in this group. In this study, patients also reported a history of childhood trauma, and some patients met criteria for PTSD. Relative habituation of heart rate to acoustic startle probes sinus tones was significantly positively correlated with dissociation as well as BPD symptom severity.
More research with control groups clinical groups with dissociative features as well as traumatized individuals who did not develop a disorder is needed to understand whether certain psychophysiological alterations may be specific to acute dissociation and to BPD.
At this point, the number of studies comparing distinct disorders is way too low to draw firm conclusions. The use of specific dissociation measurements e.
Individuals with BPD show reduced pain perception higher pain thresholds compared to healthy control groups, which correlates with emotional distress [ ] and dissociation [ 47 , ]. Reducing acute states of emotional distress and dissociation is one of the most prevalent motives for NSSI in patients with BPD [ 45 , 46 ].
During the abovementioned script-driven imagery paradigm, participants were exposed to either a personalized stressful script or a neutral script autobiographical narrative. When exposed to the stressful script, patients with acute BPD and those in remission showed enhanced dissociation along with pain hyposensitivity higher heat pain thresholds. However, a significant association between dissociation and hyposensitivity to pain analgesia was only observed in patients with acute BPD, not in those in remission.
In another study by Defrin and colleagues [ ], no significant correlation between elevated heat pain thresholds and a measure of trait dissociation DES was found in patients with acute BPD.
On the other hand, higher trait dissociation scores on the DES predicted changes in the default mode network in response to painful heat stimulation in BPD patients with current self-injurious behavior [ ]. This suggests that frequent dissociative experiences may be associated with changes in brain regions that underlie processing of pain, e.
Future studies may investigate whether alterations in pain processing e. A new avenue of research concerns experiences of body ownership, i. Alterations in body ownership may contribute to symptoms of depersonalization and somatoform dissociation.
In this study, patients with acute BPD experienced lower body ownership than healthy controls, while not differing from those with remitted BPD.
Future neurobiological studies may elucidate if reduced body ownership is linked to neurobiological alterations during acute dissociation in BPD and if this is especially the case for those who experienced child sexual abuse [ 51 , 55 , 56 ].
This interesting new research avenue may open up new targets for future research and treatment. The aim of this article was to provide an overview of current experimental neurobiological research on dissociation in BPD. Building on our previous review [ 3 ], we focused on neuroimaging studies published in or later. Since experimental research on dissociation in BPD is scarce, we also included psychophysiological and pain processing studies, as well as a study investigating the link between dissociation and body ownership, which were revealed by our literature search in relevant databases.
So far, only a few studies have used experimental paradigms to investigate the impact of dissociation on information processing in BPD [ 3 ]. Even fewer studies have directly investigated the impact of acute i.
Findings are quite diverse and need to be replicated and should therefore be considered as preliminary. Methodological differences in the measurement of dissociation e.
Up to now, it is not entirely understood whether neurobiological changes are relatively stable and linked to general dissociative tendencies, or temporary i. Moreover, future studies should address the question whether neurobiological changes during dissociation depend on the underlying psychiatric diagnosis, or whether they are transdiagnostic in nature. While altered activity in frontal regions e. To investigate the disorder-specificity of findings, which is still an open research question, studies need to include distinct psychiatric control groups, as the presence of certain comorbid diagnoses may hinder a straightforward interpretation of findings.
Shared etiologies e. Careful screening for childhood trauma, symptom severity, and comorbidities may help to improve the understanding of trauma- and non-trauma-related pathways to dissociation.
With respect to BPD, most studies used aversive stimuli to investigate the impact of dissociation on emotional processing, while dissociation may also interfere with the processing and memory of positive stimuli [ 66 ]. Previous studies observed difficulties detecting and memorizing positive social signals and events [ 57 , 62 , 63 ], and discriminating between social inclusion and exclusion [ 57 , 59 ], which may contribute to difficulties in establishing trust.
If dissociation has detrimental effects on processing and memory for both for positive and negative emotions, this may partly explain why acute dissociative symptoms can contribute to poor therapy outcome in patients with BPD [ 70 ]. Future neuroimaging studies may investigate dissociation in the context of core symptoms other than emotion dysregulation, such as impulsive and risky decision-making [ 43 ] and interpersonal functioning. Shifting the focus to the investigation of interpersonal processes e.
Individual differences may exist regarding the psychobiological markers that predicts treatment outcome [ ], and the inclusion of dissociation measures may help to improve this understanding. A combination of multiple measures e.
Thereby, future studies may also investigate if clinical interventions aimed at reducing dissociation are associated with a normalization of functional brain alterations.
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Curr Psychiatry Rep. Structural and functional brain alterations in psychiatric patients with dissociative experiences: a systematic review of magnetic resonance imaging studies. J Psychiatr Res. Biomarkers of pathological dissociation: a systematic review. Neurosci Biobehav Rev. This systematic review gives an overview of functional and structural neuroimaging studies in psychiatric groups with high dissociation and also reviews other potential biomarkers, such as psychophysiological correlates of dissociation.
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Psychol Bull. Other symptoms that a person with DID may experience include:. The diagnostic criteria for dissociative identity disorder as described in the DSM-5 are as follows:.
There has long been controversy within the field of mental health about whether or not DID exists. This has led some experts to argue that the separate identities experienced by people with DID may be the result of suggestion.
Other experts, however, argue that there are recent studies that refute this idea of suggestion. These studies have been used as evidence for the existence of actual alters. Overall, DID remains a somewhat controversial diagnosis, but it is now gaining more acceptance in the mental health community. A history of trauma is believed to play a critical role in the development of DID. People with DID often report the experience of severe repeated physical and sexual abuse during childhood and also frequently have concurrent symptoms of borderline personality disorder BPD , including:.
This may be related to the fact that childhood abuse is a risk factor for both conditions. One theory about the development of DID proposes that people with DID have experienced a psychological trauma so severe that the only way to manage that trauma is to develop very strong dissociation as a coping mechanism. People with dissociative identity disorder may experience other trauma-related symptoms, including nightmares, flashbacks, or other symptoms characteristic of post-traumatic stress disorder PTSD.
Treatment for dissociative identity disorder usually involves psychotherapy focused on helping the person integrate different personalities into a single, integrated identity. Each individual's needs will be different, but therapy typically focuses on helping the person safely process traumatic memories, improve relationships with others, and develop more effective coping skills.
There is no specific medication to treat DID, but antidepressants and anti-anxiety medications may be used to address associated symptoms of depression and anxiety. Learning new coping skills is an important aspect of managing symptoms of dissociative identity disorder. Some strategies that can help include:. If you or a loved one are struggling with dissociation or dissociative identity disorder, contact the Substance Abuse and Mental Health Services Administration SAMHSA National Helpline at for information on support and treatment facilities in your area.
For more mental health resources, see our National Helpline Database.
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