Memory and Dissociative Identity Disorder
Storing and retrieving memory doesn’t work like a memory stick because the brain processes and stores information in differently. This article will explore how memory works and some exciting new research that makes it clear that DID is not a fantasy disease, but very real.
A Short Explanation of How Memory Works
The vital structure involved in the formation of memory, the hippocampus, and the one extremely involved in the fight/flight/freeze response, the amygdala, are closely linked. In fact, damage to the amygdala will make humans unable to learn what is dangerous and to avoid that danger, while damage to the hippocampus will make it impossible for the human brain to consolidate and store new memories.
All humans understand how a memory of an event filled with emotion is easier to remember later. Memories that are traumatic seem to become entrenched in our minds in detail. Researchers are only beginning to understand the ways our brains form and store these important thought patterns.
Here is a brief description what researchers know about memory:
• Moderate trauma can enhance the consolidation of long-term memory.
• Most humans can relate to the idea that something perceived by us as traumatic tends to stay in our minds for days, or perhaps years. Because of this fact, many researchers struggle to explain why extremely traumatic memories can be lost.
• Extreme trauma can interrupt the consolidation of memory into long-term storage.
• Recent research has found that memories associated with sensations such as sight or smell may take several days to become consolidated into long- term memory.
• Sensory triggers in the now can cause “forgotten” items surface into consciousness.
• Memories that are false can be implanted and remembered as though they truly happened.
• Triggers are sensory perceptions such as smell or sound. This phenomenon occurs due to state-dependent memory where memory retrieval is more efficient when a person finds themselves in a familiar state like the one in which the memory was formed.
Memory is not an accurate recording of an event. Over time memory fades or becomes distorted by what is happening in the here and now.
What is Repressed Memory?
Repressed memory is a psychiatric phenomenon where a person recalls traumatic or stressful life events many years after the event occurred. Up to the point of remembering the trauma, the person does not fully or wholly remember what happened to them and the memory is said to have been repressed.
Memory repression is thought to be a defense mechanism that excludes the details of the trauma from conscious thought including the pain, fear, and impulses felt during the trauma.
Memory repression is a controversial concept and has been used in court to explain why a person does not remember a traumatic event until it has returned. Adults who were subjected to childhood abuse may claim they had no memory of what the person they accused of harming them did until they were well-grown.
Therapists treating vulnerable people must be extremely cautious not to suggest to their client that they have been a victim of childhood trauma, but instead allow their client to remember on their own.
Repressed and False Memory: The Memory Wars
There has been a dispute for many decades about the existence of repressed memories. Some argue that repressed memories are not possible, yet others claim they are very real and should not be dismissed. This debate is also known as the memory wars.
The debate over the existence of repressed memories came to a head in the 1990s when survivors began to come forward who recalled being traumatized by satanic rituals and sexual abuse became more prominent.
Detractors from the theory that memories can be repressed state that memory simply does not work that way in repressing and then suddenly remembering something that happened decades before. These researchers also note that they believe that the scientific evidence points toward therapists being the cause of repressed memories being remembered unintentionally as they work with their vulnerable and suggestable clientele (Loftus, 1993).
Those who are proponents of repressed memory state that most people who report repressed memory recovery do so before they attend their first therapy session and are either at home alone, or with friends or family (Chu, et al., 1999).
It is simple to see why people, even scientific minds, would reject repressed memory recovery as those who experience it often report memories of horrific events involving severe sexual and other types of abuse. It is difficult to accept that parents and friends of the person, as a child, was forced to endure such mistreatment (Lego, 1996).
False Memory Syndrome
False memory syndrome is a proposed condition where a person’s identity and relationships are deeply affected by what are said to be false memories. Proponents of false memory syndrome state or believe false memories of long-forgotten trauma are placed in the minds of those who accuse them of abuse.
This belief that false memories are responsible for the number of accusations being brought forward by overzealous therapists, has been found in some professional papers to be true, yet other papers state the opposite.
For instance, in a paper written in 1995 by Lindsay & Read stated the following in their abstract:
“The authors review and critically evaluate scientific evidence regarding recovered memories of childhood sexual abuse and discuss the implications of this evidence for professional psychology, public policy, and the law. The discussion focuses primarily on abuse memories recovered through “memory work” by people who previously believed that they were not sexually abused as children.
The authors argue that memory work can yield both veridical memories and illusory memories or false beliefs, and they discuss factors that could be used to weigh the credibility of allegations based on recovered memories. The article offers tentative recommendations regarding public education, training and certification of psychotherapists, guidelines for trauma-oriented psychotherapy, research initiatives, legislative actions, and legal proceedings.”
Their paper, and those like it, propose that memories of abuse from long ago aren’t repressed memories resurfacing but phantoms made of the imagination formed when a suggestible subject is given cues through working with a therapist.
There was an organization begun in 1992 by parents of adult children who accused them of sexual abuse. Pamela Freyd, PhD served as executive director and oversaw the programs and fiscal responsibilities of the foundation. No one will ever know if those of the False Memory Foundation were actually guilty of the crimes of which they were accused.
The foundation closed its doors on December 31, 2019, after 27 years of operation leaving behind many unanswered questions.
This author does not dispute the existence of false memories as they are a matter of everyday experience for all humans. However, to offhandedly dismiss as untrue the recovered memories of thousands of people is improper to say the least.
Imitated Dissociated Identity Disorder and Describing Dissociative Identity Disorder
There has always been a problem authenticating dissociative identity disorder even with the use of clinically written tests. Since all psychology involves self-reporting, it is remiss to say that DID is any different in that no one can know for sure if someone truly has it, is faking, or believes they have the diagnosis but do not.
In an effort to help with this dilemma, the ICD-10 and the DSM-5tr attempt to describe in detail what criteria must be met to gain the diagnosis of dissociative identity disorder.
The criteria in the DSM-5tr that must be met for a diagnosis of DID to be given are as follows:
A. Disruption of identity is characterized by two or more distinct personality states, which may be described in some cultures as an experience of possession. The disruption in identity involves marked discontinuity in sense of self and sense of agency, accompanied by related alterations in affect, behavior, consciousness, memory, perception, cognition, and/or sensory-motor functioning. These signs and symptoms may be observed by others or reported by the individual.
B. Recurrent gaps in the recall of everyday events, important personal information, and/or traumatic events that are inconsistent with ordinary forgetting.
C. The symptoms cause clinically significant distress or impairment in social, occupational, or other important areas of functioning.
D. The disturbance is not a normal part of a broadly accepted cultural or religious practice. Note: In children, the symptoms are not better explained by imaginary playmates or other fantasy play.
E. The symptoms are not attributable to the physiological effects of a substance (e.g., blackouts or chaotic behavior during alcohol intoxication) or other medical condition (e.g., complex partial seizures) (American Psychiatric Association, 2022).
The World Health Organization in the ICD-10 states the following.
ICD-11 Dissociative identity disorder 6B64
Dissociative identity disorder is characterized by disruption of identity in which there are two or more distinct personality states (dissociative identities) associated with marked discontinuities in the sense of self and agency. Each personality state includes its own pattern of experiencing, perceiving, conceiving, and relating to self, the body, and the environment.
At least two distinct personality states recurrently take executive control of the individual’s consciousness and functioning in interacting with others or with the environment, such as in the performance of specific aspects of daily life such as parenting, or work, or in response to specific situations (e.g., those that are perceived as threatening).
Changes in personality state are accompanied by related alterations in sensation, perception, affect, cognition, memory, motor control, and behavior. There are typically episodes of amnesia, which may be severe.
The symptoms are not better explained by another mental, behavioral, or neurodevelopmental disorder and are not due to the direct effects of a substance or medication on the central nervous system, including withdrawal effects, and are not due to a disease of the nervous system or a sleep-wake disorder. The symptoms result in significant impairment in personal, family, social, educational, occupational, or other important areas of functioning.
Distinguishing Real DID from Malingering
Dissociative identity disorder is all over the internet in videos and vivid descriptions and also on television and the big screens in movies. It is easy to see why some vulnerable people may believe they have dissociative identity disorder when they do not.
There are several reasons someone would feign DID including a need to appear sick, legal motivations, or because multiplicity has become a fad on social media.
It is critical to remember that most people who are malingering are not doing so to be malicious, instead they may truly believe they have the symptoms of DID and will experience deep disappointment or anger when they find out they do not.
When someone presents with questionable DID symptoms, they tend to overreport and overemphasize well-known symptomology and underreport others. The symptoms they claim tend to mimic the best known symptom of having alternate personality states and report outlandish stories of which they seem to take pleasure reporting.
People who truly have DID tend to want to hide their symptoms and are upset greatly by the diagnosis they have just received. They exhibit fear and are not in the least happy they have received the diagnosis of DID.
One can be given the DES Scale (Dissociative Experiences Scale) test, however, I is easy to defeat because of widespread knowledge of it on the Internet. Also, the test tends to be inconclusive.
A brain-imaging study conducted in 2012 utilized 11 patients with DID, 10 high fantasy prone people who simulated DID, and 8 low fantasy prone people who simulated DID. The identity states in DID were not convincingly engaged and important differences in regional cerebral blood flow were seen (Reinder et al., 2012).
Importantly, the study was replicated and the same conclusions were reached.
This was the first multi-participant, stimulus-driven, brain imaging study and the findings secured the fact that the fantasy model of DID was incorrect.
fMRI studies of people who live with dissociative identity disorder have been performed to see if there is a neurological component to the disorder (Schlumpf, 2013).
Not only is the therapist of a suspected case of DID able to tell real from malingered DID through behaviors, but fMRI studies have shown the difference.
A quote from Dr. Simone Reinders sums up this chapter:
“Brain imaging can also be useful for diagnosing DID using ‘pattern recognition techniques’ – these are mathematical procedures that focus on the automatic discovery of regularities and relations in data – a first study has shown. Future studies are needed to make sure that brain scans are being used effectively in healthcare, but these data-driven methodologies hold great promise for the future.”
Ending Our Time Together
I have memory problems myself with not remembering conversations, etc. It is difficult to maneuver through life especially when dealing with friends and loved ones.
Understanding that dissociative identity disorder can now be proven to be real with the use of fMRI studies. That to me is exciting. Perhaps scientists and physicians will invent a new treatment in the near future that is not as hard on their patients as therapy is today.
References
Bass, C., & Halligan, P. (2014). Factitious disorders and malingering: challenges for clinical assessment and management. The Lancet, 383(9926), 1422-1432.
Belli, R. F. (2012). Introduction: In the aftermath of the so-called memory wars. In R. F. Belli (Ed.), True and false recovered memories: Toward a reconciliation of the debate (pp. 1–13). Springer Science + Business Media. https://doi.org/10.1007/978-1-4614-1195-6_1
Brand, B. L., McNary, S. W., Loewenstein, R. J., Kolos, A. C., & Barr, S. R. (2006). Assessment of genuine and simulated dissociative identity disorder on the Structured Interview of Reported Symptoms. Journal of Trauma & Dissociation, 7(1), 63-85. doi:10.1300/j229v07n01_06
Chu JA, Frey LM, Ganzel BL, Matthews JA. Memories of childhood abuse: dissociation, amnesia, and corroboration. Am J Psychiatry. 1999 May;156(5):749-55. doi: 10.1176/ajp.156.5.749. PMID: 10327909.
Coons, P. M., & Milstein, V. (1994). Factitious or malingered multiple personality disorder: Eleven cases. Dissociation, 7(2).
Lego, S. (1996). Repressed memory and false memory. Archives of psychiatric nursing, 10(2), 110-115.
Lindsay, D. S., & Read, J. D. (1995). ” Memory work” and recovered memories of childhood sexual abuse: Scientific evidence and public, professional, and personal issues. Psychology, Public Policy, and Law, 1(4), 846.
Loftus, E. F. (1993). The reality of repressed memories. American psychologist, 48(5), 518.
Loftus, E. F., Garry, M., & Feldman, J. (1994). Forgetting sexual trauma: What does it mean when 38% forget?.
Loftus, Elizabeth; Ketchum, Katherine (1994). The Myth of Repressed Memory: False Memories and Allegations of Sexual Abuse. New York, NY: St. Martin’s Press. ISBN 0312114540.
Loewenstein, R. J. (2022). Dissociation debates: Everything you know is wrong. Dialogues in clinical neuroscience.
Madrid, C. (2012, November 21). The lying disease: Why would someone want to fake a serious illness on the internet? Retrieved May 24, 2015, from http://www.thestranger.com/seattle/the-lying-disease/Content?oid=15337239
Pietkiewicz, I. J., Bańbura-Nowak, A., Tomalski, R., & Boon, S. (2021). Revisiting false-positive and imitated dissociative identity disorder. Frontiers in psychology, 12, 637929.
Reinders, AATS, Willemsen, ATM, Vos, HPJ, den Boer, JA, Nijenhuis, ERS. Fact or factitious? A psychobiological study of authentic and simulated dissociative identity states. PLoS One 2012; 7: e39279.
Schlumpf, Y. R., Nijenhuis, E. R., Chalavi, S., Weder, E. V., Zimmermann, E., Luechinger, R., … & Jäncke, L. (2013). Dissociative part-dependent biopsychosocial reactions to backward masked angry and neutral faces: An fMRI study of dissociative identity disorder. NeuroImage: Clinical, 3, 54-64.
Thomas, A. (2001). Factitious and malingered dissociative identity disorder: Clinical features observed in 18 cases. Journal of trauma & dissociation, 2(4), 59-77.
Tsai, G. E., Condie, D., Wu, M. T., & Chang, I. W. (1999). Functional magnetic resonance imaging of personality switches in a woman with dissociative identity disorder. Harvard review of psychiatry, 7(2), 119-122.
Vissia, E. M., Lawrence, A. J., Chalavi, S., Giesen, M. E., Draijer, N., Nijenhuis, E. R., … & Reinders, A. A. (2022). Dissociative identity state-dependent working memory in dissociative identity disorder: a controlled functional magnetic resonance imaging study. BJPsych Open, 8(3), e82.
Welburn, K. R., Fraser, G. A., Jordan, S. A., Cameron, C., Webb, L. M., & Raine, D. (2003). Discriminating dissociative identity disorder from schizophrenia and feigned dissociation on psychological tests and structured Interview. Journal of Trauma & Dissociation, 4(2), 109-130. doi:10.1300/j229v04n02_07
Excellent, Shirley!!!