title: Fact or factitious? A psychobiological study of authentic and simulated dissociative identity states.
abstract: BACKGROUND
  Dissociative identity disorder (DID) is a disputed psychiatric disorder. Research findings and clinical observations suggest that DID involves an authentic mental disorder related to factors such as traumatization and disrupted attachment. A competing view indicates that DID is due to fantasy proneness, suggestibility, suggestion, and role-playing. Here we examine whether dissociative identity state-dependent psychobiological features in DID can be induced in high or low fantasy prone individuals by instructed and motivated role-playing, and suggestion.
  
  
  RESULTS
  DID patients, high fantasy prone and low fantasy prone controls were studied in two different types of identity states (neutral and trauma-related) in an autobiographical memory script-driven (neutral or trauma-related) imagery paradigm. The controls were instructed to enact the two DID identity states. Twenty-nine subjects participated in the study: 11 patients with DID, 10 high fantasy prone DID simulating controls, and 8 low fantasy prone DID simulating controls. Autonomic and subjective reactions were obtained. Differences in psychophysiological and neural activation patterns were found between the DID patients and both high and low fantasy prone controls. That is, the identity states in DID were not convincingly enacted by DID simulating controls. Thus, important differences regarding regional cerebral bloodflow and psychophysiological responses for different types of identity states in patients with DID were upheld after controlling for DID simulation.
  
  
  CONCLUSIONS
  The findings are at odds with the idea that differences among different types of dissociative identity states in DID can be explained by high fantasy proneness, motivated role-enactment, and suggestion. They indicate that DID does not have a sociocultural (e.g., iatrogenic) origin.
authors: King's College London, Institute of Psychiatry, Department of Psychosis Studies, London, United Kingdom. a.a.t.s.reinders@gmail.com
authors: A A T S
authors: AA
authors: Reinders
authors: A A T Simone
authors: AA
authors: Reinders
authors: Antoon T M
authors: AT
authors: Willemsen
authors: Herry P J
authors: HP
authors: Vos
authors: Johan A
authors: JA
authors: den Boer
authors: Ellert R S
authors: ER
authors: Nijenhuis
mesh_terms: D000328:Adult; D001341:Autonomic Nervous System / Q000503:physiopathology; D001921:Brain / Q000098:blood supply / Q000473:pathology / Q000503:physiopathology; D002319:Cardiovascular System / Q000503:physiopathology; D002560:Cerebrovascular Circulation / Q000502:physiology; D009105:Dissociative Identity Disorder / Q000473:pathology / Q000503:physiopathology / Q000523:psychology*; D004644:Emotions; D005201:Fantasy; D005260:Female; D006801:Humans; D019018:Imagery, Psychotherapy; D061212:Memory, Episodic; D012039:Regional Blood Flow / Q000502:physiology