Excerpts from "A New Model of Dissociative Identity Disorder," by Paul F. Dell, PhD

A New Model of Dissociative Identity Disorder by Paul F. Dell, PhD.

The subjective/phenomenological model of pathological dissociation Is actually a generalized formulation of the eight Schneiderian passive-influence experiences. According to the subjective/phenomenological model of pathological dissociation, the phenomena of pathological dissociation are recurrent, jarring intrusions into executive functioning and sense of self by self-states or alter personalities. Such dissociative phenomena are startling, alien invasions of one’s mind, functioning, and experience. These intrusions are always confusing [65–67] and often frightening. They frequently cause persons who are dissociative to fear for their sanity. The subjective/phenomenological model of pathological dissociation has four corollaries.

Pathological dissociation can affect every aspect of human experience No aspect of human experience is immune to invasion by dissociative symptoms. Dissociative intrusions can affect one’s conscious awareness and one’s experience of one’s body, world, self, mind, agency, intentionality, thinking, believing, knowing, recognizing, remembering, feeling, wanting, speaking, acting, seeing, hearing, smelling, tasting, and touching.

Most phenomena of pathological dissociation are subjective and invisible. The overwhelming majority of dissociative phenomena are subjective and invisible, rather than objective and visible [4]. Relatively few objective signs of dissociation exist, and the few objective signs that do exist are unreliably discerned, even by well-trained observers [68].

There are two major kinds of pathological dissociation: intrusions and amnesias

Two major kinds of pathological dissociation exist: dissociative symptoms that are partially dissociated from consciousness (intrusions), and strictly speaking, identity confusion is not a dissociative intrusion. Rather, identity confusion is the result of undergoing recurrent dissociative intrusions. 

Testing the subjective/phenomenological model of dissociative identity disorder because no instrument comprehensively measured the hypothesized dissociative symptom-domain of DID, it was necessary to develop the Multidimensional Inventory of Dissociation (MID) [65]. The MID has 23 dissociation scales that assess the subjective/phenomenological domain of pathological dissociation and the hypothesized dissociative symptom-domain of DID (see Box 1).

DELLTable 2

Incidence of 23 dissociative symptoms in 220 persons who have dissociative identity disorder

General dissociative symptoms:

Memory problems (5/12) 100 94 93 98

Depersonalization (4/12) 95 95 94 98

Derealization (4/12) 93 92 89 98

Posttraumatic flashbacks (5/12) 93 92 90 96

Somatoform symptoms (4/12) 83 83 81 88

Trance (5/12) 88 87 84 96

Partially-dissociated intrusions

Child voices (1/3) 95 95 94 95

Internal struggle (3/9) 100 96 95 98

Persecutory voices (2/5) 88 90 87 96

Speech insertion (2/3) 85 83 81 86

Thought insertion/withdrawal (3/5) 93 91 90 95

‘‘Made’’/intrusive emotions (4/7) 95 91 90 96

‘‘Made’’/intrusive impulses (2/3) 85 89 87 93

‘‘Made’’/intrusive actions (4/9) 98 95 93 98

Temp loss of knowledge (2/5) 90 82 80 91

Self-alteration (4/12) 98 95 94 98

Self-puzzlement (3/8) 98 95 93 98

Fully-dissociated intrusions (ie, amnesia)

Time Loss (2/4) 88 88 87 89

‘‘Coming to’’ (2/4) 78 79 75 88

Fugues (2/5) 83 75 71 86

Being told of actions (2/4) 85 86 85 88

Finding objects (2/4) 61 74 72 77

Evidence of actions (2/5) 71 77 76 81

Abbreviations: MID ¼ multidimensional inventory of dissociation; SCID-D, Structured Clinical Interview for DSM-IV Dissociative Disorders-Revised; Temp loss of knowledge, temporary loss of well-rehearsed knowledge or skills; Self-alteration, experiences of self-alteration; Being told of actions, being told of disremembered actions; Finding objects, finding objects among one’s possessions; Evidence of actions, finding evidence of ones recent actions. The first numeral is the number of items that must receive a clinically-significant rating by the test-taker for that symptom to be considered present; the second numeral is the number of items on that scale.

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