Psychotic presentations of dissociative disorders

Abstract

Dissociative identity disorder (DID) is both a disorder of one’s sense of self and an effective developmental adaptation to childhood trauma. Controversies surrounding DID, historically, have impeded its study. However, a burgeoning body of research links DID to a particular causal environment and biological correlates. Here we provide an innovative theory of DID that translates the phenomenology using modern models of cognition and neuroscience to ground DID in environmental experience, the brain and body. Research suggests DID self-states are dynamic, distributed networks of brain activity that prepare the body to interact with the world. Furthermore, a constellation of early childhood trauma and dysfunctional family dynamics interact with a genetic predisposition for the capacity to dissociate to cause DID. DID has distinct patterns in brain structure, function, and peripheral psychophysiology, and cutting-edge neuroscience suggests there may be a measurable fingerprint of DID distinguishable in the brain on an individual basis. Altogether, this novel synthesis has demonstrated what many clinicians and people with lived experience have long known – DID is a valid disorder and a developmental posttraumatic adaptation. Yet many fruitful directions for future work in development, distinguishing pre-existing neural vulnerabilities versus corollaries of DID, integration, treatment, and the biology of recovery remain.