Behavioural and Neurocorrelates of Self-relevance Processing in Dissociative Identity Disorder: A Controlled Study
October 22, 2023
Dissociative identity disorder (DID) is characterized by, among others, the recurrence of different dissociative identity states and disrupted memory function (Reinders & Veltman, 2021). Several studies have been conducted as part of the Dutch Neuroimaging Dissociative Identity Disorder project and publications can be found at www.neuroimaging-DID.com. In this study, individuals diagnosed with DID participated twice, once in a neutral identity state (NIS) and once in a trauma-related identity state (TIS). Several control groups and conditions were included, such as actors simulating DID, also participating twice as, NIS and TIS and a carefully paired control group consisting of healthy participants to represent the NIS and of individuals with a diagnosis of post-traumatic stress disorder (PTSD) to represent the TIS. This symposium will present results of the self-relevance sub study. Participants attended the research facilities approximately 6 weeks before the brain imaging study. During this session they rated words with respect to valence and self-relevance in their two identity states. The identity-state dependent and self-relevant words with the highest scores were then presented during the brain imaging session. This symposium is divided in an introduction, four papers and a Q&A session. The first part will introduce the study design and explain the task (see also Vissia et al., 2016). The first paper presents a study that investigated the degree to which different identity states report autobiographical knowledge over time. This longitudinal study was the first to confirm clinical observations that self-relevant and emotional processing are different between individuals with DID and simulating controls, but consistent over time. Furthermore, these findings inform on the stability of identity state-dependent knowledge over time and is therefore clinically relevant, informing on knowledge containment across treatment sessions. The second paper that will be presented investigated the behavioural and neural correlates of subjectively reported inter-identity amnesia in the NIS, also called the trauma-avoidant identity state, of trauma-related knowledge specific to the trauma-related identity state. Results show brain networks involved in the avoidant processing of trauma-related information which are similar to those found in previous studies. Behavioural measures did not support the notion of inter-identity amnesia and are thereby in line with previous reports (see for review Reinders et al., 2022). The third paper presents a study into the imaging and behavioural correlates of overt and covert processing (Schlumpf et al., 2013) of self-relevance information in individuals with DID. Findings suggest that significant brain activation differences are observed between participants with DID and controls, especially for the processing of trauma-related self-relevance words. Moreover, statistically significant differences between overt and covert self-relevance processing were observed. The final paper will present connectivity analyses on the data. The results in the first papers revealed localized brain activations in relation to the task conditions. This final paper will shed light on how these brain regions interact (Reinders et al., 2023; Roydeva & Reinders, 2021). Following this, there will be time for questions.
Potential to Distress:
At the conclusion of this presentation, participants will be able to:
- Describe the key characteristics of a study design investigating self-relevance knowledge evaluation in dissociative identity disorder
- Evaluate the clinical importance of knowledge stability over time in identity states in DID
- Describe why “inter-identity avoidance” of trauma-related knowledge is likely a better definition than “inter-identity amnesia”
- Discuss neural and behavioural processing differences between neutral and trauma-related identity states, as well as between consciousness levels
- Assess the difference between regional and connectivity approaches in brain research.
Presenter: A.A.T. Simone Reinders, PhD
Presenter Bio: Dr Reinders is a honorary Senior Research Associate with Lecturer status at the Department of Psychological Medicine, Institute of Psychiatry, Psychology and Neuroscience (IoPPN), King's College London (KCL). Dr Reinders is a leader in the field of the neurocorrelates of pathological dissociation, having received multiple awards from the ISSTD for her work in this area, including a Mid Career Achievement Award in 2021. She is considered an international expert in the neurobiology of pathological dissociation as evidenced by invitations to deliver plenaries at international conferences.
As part of her PhD Dr Reinders has worked on the Frontiers of Psychiatry and was among the first to publish on brain imaging in pathological dissociation. Her research was the first to show, on the basis of brain activation data, that different personality states in patients with dissociative identity disorder (DID) show different brain activation patterns in response to listening to trauma-related autobiographical texts. In a recent publication Dr Reinders showed how brain imaging can aid the diagnosis of DID using machine learning algorithms. This paper was awarded the 2020 Pierre Janet Writing Award of the International Society for the Study of Trauma and Dissociation (ISSTD), which is given to an individual for the best clinical, theoretical or research paper in the field of dissociation and/or trauma within the past year. This award follows other awards such as the Morton Prince Award for Scientific Achievement (2017) of the ISSTD given for outstanding cumulative contributions to research in the area of dissociative disorders.
Presenter: Aikaterini I. Strouza, GMBPsS, MSc
Presenter Bio: Aikaterini (Katerina) Strouza is a PhD candidate at the Department of Psychiatry, Amsterdam UMC, Location VUmc Amsterdam. Katerina graduated with Distinction from the Institute of Psychiatry, Psychology and Neuroscience (IoPPN), King's College London (KCL) with a Master of Science degree in Mental Health Studies. Dr A.A.T. Simone Reinders supervised Katerina’s master’s thesis titled “A longitudinal study of personality state dependent self-relevance ratings in dissociative identity disorder”, which earned a Distinction. Since then, she has been conducting research on dissociative identity disorder as a member of Dr Reinders’ team. The research for her PhD involves the investigation of self-relevance processing. One study investigates the longitudinal aspects of self-relevance processing and another study investigates the behavioural and neural correlates of overt and covert self-relevance information processing. Katerina is a member of various international societies and associations, and has previously submitted scientific articles and posters in international conferences. Apart from her research activities, Katerina also has clinical experience in adult and child populations, in various settings based in Greece and the United Kingdom. Furthermore, her educational background also includes postgraduate certificates on clinical psychopathology and child psychology, as well as training courses on various therapeutic treatments and techniques.
Presenter: Lora I. Dimitrova, MSc
Presenter Bio: Lora Dimitrova is a PhD student affiliated with both King’s College London (UK) and the VU University Amsterdam (NL). Lora completed her bachelor’s degree in Psychology at Kingston University with a distinction. She completed her master’s in Mental Health Studies at King’s College London under the supervision of Dr A. A. T. S. Reinders and received a distinction as well. She is currently also working as a research assistant at the Clinic for Dissociative Studies (CDS-UK) alongside her PhD. For her thesis she is interested in the aetiology of dissociative identity disorder and in the neurofunctional and neurostructural biomarkers of pathological dissociation and traumatization. Some notable publications include “A neurostructural biomarker of dissociative amnesia: a hippocampal study in Dissociative Identity Disorder” and “Sleep, trauma, fantasy and cognition in dissociative identity disorder, post-traumatic stress disorder and healthy controls: a replication and extension study”. The most recent research studies inter-identity amnesia in DID using behavioural and neurobiological data.
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