What Should We Call the Whatchmacallits? Proposed Changes in the Nosological Language for Dissociative Identity Disorder (DID): Self-States, Identity, and Personality
This lecture summarizes Dr. Loewenstein’s reviews with Frank W. Putnam, M.D. of Discrete Behavioral State Theory (DBST) and his own review of Conceptual Foundations for Long- Term Psychotherapy of Dissociative Identity Disorder, chapters in the recently published Dissociation and the Dissociative Disorders. Past, Present, and Future, 2nd Edition, edited by Dorahy, Gold, and O’Neill. He will begin by giving an overview of DBST: a transtheoretical, transdiagnostic model of human consciousness that organizes a wide variety of data from genetics, neurobiology, brain, mind, and behavior and to provide a superordinate theory of most aspects of human functioning. DBST provides a unifying framework of many psychiatric disorders as “state-change disorders”, as well problematic behaviors such as addictions or nonsuicidal self-injury as attempts to modulate and modify problematic states. DBST provides an overarching framework for conceptualizing child development and normal and pathological attachment processes. DBST subsumes all other theories of dissociation and dissociative disorders (e.g., structural dissociation theory, auto-hypnotic theories, etc.). In particular, DBST provides a developmental framework for understanding DID as an early-childhood onset disorder with lack of unification of sense of self across states, contexts, and relationships. Subsequently, Dr. Loewenstein will discuss conceptualization of self, identity, and personality in a variety of literatures. As in our field, these terms are often used interchangeably and tautologically. He argues that “self” describes “who” we are; “identity” delineates “what” we are; “personality” represents long-term tolerances and functional domains, perhaps “where” self and identity develop and exist. Dr. Loewenstein reviews data from a series of studies on the psychological organization of DID that describe a specific, characteristic personality organization in DID. Consistent with DBST, these studies describe DID as an alternative developmental pathway that includes frequent, idiosyncratic posttraumatic responding with variably effective dissociative and/or auto-hypnotic defenses to attenuate these responses. At the same time, he will enumerate how early life dissociation preserves vital strengths and resiliencies that can subserve recovery. Dr. Loewenstein proposes that the appropriate developmental term is dissociative self-state(s), often organized into self-state systems. Identity and identity states represent the secondary structuring of these self-states with a variety of descriptors and ascriptions. Self-states and identity states interact in all of us and in DID. Personality should be reserved for the overall personality organization of DID that represents broad-based capacities and functions that may be partly personified as self-states, but also represent many of the non-dissociative aspects of the mind of DID individuals. Dr. Loewenstein has had a longstanding concern with terms that reify mental processes; that we often fail to recognize that we only describe mental/psychological processes metaphorically – and our metaphors may shape how we conceptualize psychological functioning. Dr. Loewenstein will discuss terminology to better characterize DID self-states in terms of developmental adaptation and illustrate that language shapes our view of DID states (e.g., “helper”, “malevolent”, “persecutory”, “child”, etc.), and how alternative language can shift these views. He will propose standardizing our nosological language to use self-state(s) as the preferred terminology for DID.
Learning Objectives:
At the conclusion of this session participants will be able to:
Explain the principles of Discrete Behavioral States Theory
Conceptualize dissociative and trauma-and-stressor-related disorders as state-change disorders, among many other disorders and problematic behaviors (e.g., nonsuicidal self-injury)
Explain DID as a posttraumatic developmental disorder where the traumatized child fails to develop a unified sense of self across states and contexts, not a “shattered” mind that was previously cohesive
Describe the psychological organization of DID and how this predicts posttraumatic responding during psychotherapy as well as crucial resiliencies that can underlie the positive response of DID individuals to psychotherapy
Discuss the logic for preferring the terminology of self-state(s) for the subjective self-divisions in DID in preference to “identity/identity state(s)” or “personality/personality state(s)”, dissociative “part(s) of the personality”, “alter(s)”, etc