The Sense of Self Over Time: Assessing Diachronicity in Dissociative Identity Disorder, Psychosis and Healthy Comparison Groups

Abstract

Dissociative experiences have been associated with diachronic disunity. Yet, this work is in its infancy. Dissociative identity disorder (DID) is characterized by different identity states reporting their own relatively continuous sense of self. The degree to which patients in dissociative identity states experience diachronic unity (i.e., sense of self over time) has not been empirically explored. This study examined the degree to which patients in dissociative identity states experienced diachronic unity. Participants were DID adults (n=14) assessed in adult and child identity states, adults with a psychotic illness (n=19), adults from the general population (n=55), children from the general population (n=26) and adults imagining themselves as children (n=23). They completed the Diachronic Disunity Scale (DDS), the Dissociative Experiences Scale (DES), and the Self-Concept Clarity Scale (SCCS). Diachronic disunity was not limited to psychiatric groups, but evident to some degree in all adult and child samples. The DID adult sample experienced more dissociation and self-confusion than the psychosis and adult comparison groups, but did not differ on the diachronic measure. DID patients in their child identity states and child comparisons showed disunity and were significantly different from child simulators, who showed relatively more unity. Results suggest that DID patients in either adult or child dissociative identity states, like those in other samples, do not universally experience themselves as having a consistent sense of self over time.

The memory and identity theory of ICD-11 complex posttraumatic stress disorder.

“…A sense of self that is experienced as fragmented, nonexistent, and unstable over time is thought to be a common feature of dissociative disorders, BPD, and some forms of psychosis (Dorahy et al, 2021; Fuchs, 2007; van der Hart et al, 2006). Thus, we propose that comorbidities between ICD-11 CPTSD and these disorders will relate strongly to a poorly developed identity or to multiple contradictory identities, together with high levels of poorly integrated prereflective experience.…”

Predictors of diachronic disunity measures in the general population: An assessment of dissociation, autobiographical memory functions, well-being, and sense and clarity of self.

“…The use of a general population sample also impedes the potential accuracy of any clinical implications; therefore, the impact of dissociation and self-concept on diachronicity in those with mental health difficulties, while controlling for theoretically related variables (e.g., autobiographical memory functioning, subjective well-being) awaits investigation. Disorders associated with major aberrations in self-functions, like schizophrenia and dissociative identity disorder, may provide effective insights if assessed on these variables (e.g., Dorahy et al, 2021). Such samples may also provide a better assessment of whether state dissociation meaningfully relates to diachronicity, given the low levels of this form of dissociation in the sample.…”

“…Given the focus of this study, only diachronicity scores were used. While existing psychometric data are limited on this measure, in part because it uses a single item to address diachronicity, it has been used in several studies (e.g., Dorahy et al, 2021; Lampinen et al, 2004). Lampinen et al (2004) did find associations between DDS scores and measures thought to be associated with diachronicity (e.g., having more self-defining memories), which offers some support for the instrument’s validity.…”

“…Those with higher levels of pathological dissociative symptoms (e.g., amnesia, depersonalization, voice hearing) reported more diachronic disunity. Dorahy et al (2021) found diachronic disunity was present in approximately half of those people with dissociative disorders. The relationship between trait dissociation and a noncontinuous sense of self prompted Lampinen et al (2004) to suggest that diachronicity ratings should be examined while dissociation was occurring (i.e., state dissociation).…”

The Blurring of Boundaries in Bioscientific Discourse

“…(2015,5) What is here of special importance, however, is that although I have no direct phenomenological experience of a cross-temporal identity of the self as something that lasts "from thought to thought" (Strawson 2017, 35), frequent gaps in the stream of consciousness, such as dreamless sleep, cannot weaken my awareness of this enduring self just as changes within our minds and bodies are incapable of so doing. Squire et al (1981), Tulving (1993), Klein et al (2002), Rathbone et al (2014), and Dorahy et al (2021) refer to cases of patients suffering from severe memory impairments, dissociative identity disorder, and cognitive impairments, who despite a loss of "access to a variety of self-relevant sources of knowledge" (Klein 2012, 478) possessed a coherent sense of self which had not collapsed under the weight of cognitive disorders. But if this is the case, then terms like the "loss of self", 38 "damaged self", or "loss of sense of personal identity" are rather hyperbole and constructions suffering from a lack of distinction between the "self" and "selfconcept", "self-image", "the autobiographical self", "the narrative self", and so on.…”