Conceived and designed the experiments: AATSR ATMW JAB ERSN. Performed the experiments: AATSR HPJV. Analyzed the data: AATSR ATMW. Wrote the paper: AATSR ATMW HPJV JAB ERSN.
The authors have declared that no competing interests exist.
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.
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.
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.
Despite its inclusion in the Diagnostic Manual for Mental Disorders
The non-trauma-related position
To date, the position that DID is caused by sociocultural factors and personal features such as fantasy proneness has not been tested in studies involving DID patients, and evidence that the complex phenomenology and psychobiology of DID can be created and sustained over time by these factors is lacking
The trauma-related perspective entails that DID is related to a combination of factors that include chronic emotional neglect and emotional, physical, and/or sexual abuse from early childhood, insufficient integrative capacity, attachment disorder, and lack of affect-regulation by caretakers
Holders of the trauma-related view acknowledge that: some features of dissociative identity states can be influenced by sociocultural factors
According to the DSM-IV
Proponents of the sociocognitive view have argued that the different patterns of subjective, psychophysiological, and neural activity for NIS and TIS in response to a trauma-memory script that Reinders et al.
The
Twenty-nine subjects participated in the brain imaging study: 11 patients with dissociative identity disorder (DID), 10 high fantasy prone DID simulating controls, and 8 low fantasy prone DID simulating controls. The controls were instructed to enact the two DID identity states: a neutral identity state (NIS) and a trauma-related identity state (TIS). Brain imaging data, autonomic (systolic and diastolic blood pressure, discrete heart rate and heart rate variability (HRV)) and subjective (controls’ subjective sensorimotor and emotional experiences) reactions were obtained. DID patients, as well as high fantasy prone and low fantasy prone controls were studied in the two different types of identity states during a memory script (MS) driven (neutral or trauma-related autobiographical texts) imagery paradigm. The brain imaging data of the three groups was statistically analyzed in SPM5 in a three-by-two-by-two factorial design which allows for the assessment of various effects, e.g., main effects and simple subtraction analyses (within and between identity state) within and between the three groups.
Statistical results of the autonomic and subjective reactions analyses between the three groups are presented in
|
|
|||||||||||
DIS | DIS |
MS | MS |
DIS |
DIS |
DIS | DIS |
MS | MS |
DIS |
DIS |
|
|
||||||||||||
sensory rating | <0.001 |
<0.001 |
<0.001 |
<0.001 |
<0.001 |
<0.001 |
<0.001 |
<0.007 |
<0.001 |
<0.001 |
<0.001 |
0.001 |
emotional rating | <0.001 |
n.s. | <0.001 |
0.001 |
<0.001 |
0.031 |
<0.001 |
0.076 | <0.001 |
<0.001 |
<0.001 |
0.030 |
|
||||||||||||
heart rate frequency | 0.011 |
0.002 |
<0.001 |
<0.001 |
0.009 |
0.036 |
0.018 |
0.010 |
<0.001 |
<0.001 |
0.021 |
0.023 |
systolic blood pressure | 0.058 | 0.015 |
0.006 |
0.005 |
0.044 |
0.018 |
0.080 | 0.034 |
0.006 |
0.025 |
0.017 |
n.s. |
diastolic blood pressure | 0.043 |
n.s. | 0.001 |
0.002 |
n.s. | n.s. | n.s. | n.s. | 0.001 |
0.004 |
n.s. | n.s. |
HRV-AVG | n.s. | 0.078 | 0.006 |
0.003 |
0.017 |
0.036 |
n.s. | n.s. | 0.009 |
0.015 |
0.054 | 0.033 |
Factorial statistical analyses of the between group (DID versus high or low fantasy prone DID simulating healthy controls, respectively) subjective reactions (emotional and sensori-motor ratings) and autonomic (discrete heart rate, systolic and diastolic blood pressure and heart rate variability) measurements. The statistical analyses consist of the two main effects and the accompanying interaction effect. Statistical values are reported in
=
=
DID = dissociative identity disorder.
CH = high fantasy prone DID simulating controls.
CL = low fantasy prone DID simulating controls.
DIS = dissociative identity state.
DIS*Group = interaction effect.
MS = memory script.
MS*Group = interaction effect.
DIS * MS = interaction effect.
DIS*MS*Group = interaction effect.
HRV-AVG = average of normal-to-normal time intervals.
The dashed line depicts the response of the neutral identity state (NIS) when listening to the neutral or trauma-related memory script (MS). The solid line depicts the response of the traumatic identity state (TIS) when listening to the neutral or trauma related MS. All three groups are presented per variable: the dissociative identity disorder patients (DID) in pink, the high fantasy prone DID simulating controls (CH) in cyan and the low fantasy prone DID simulating controls (CL) in blue. See
T-tests were used to test if a significant (
|
|
||||||||||||||||
DID only | DID - CH | DID - CL | |||||||||||||||
L/R | Brain region |
BA | x | y | z | T | kE | x | y | z | T | kE | x | y | z | T | kE |
|
|||||||||||||||||
|
|||||||||||||||||
L | Insula | BA 13 |
−46 | −20 | 14 | 4.76 | 258 |
−46 | −24 | 18 | 4.41 |
302 |
|||||
R | Insula | BA 13 |
32 | −24 | 18 | 3.87 | 42 |
46 | −2 | 22 | 3.98 |
1201 |
|||||
L | Orbitofrontal cortex | BA 11 |
−30 | 34 | −22 | 3.95 | 96 | ||||||||||
BA 11 |
−24 | 56 | −20 | 3.73 | 61 | ||||||||||||
L | Parietal operculum |
BA 40 |
−54 | −14 | 16 | 4.02 | 258 |
−54 | −14 | 16 | 3.45 |
302 |
|||||
R | Parietal operculum |
BA 40/43 |
52 | 2 | 20 | 3.97 | 64 |
||||||||||
BA 40/43 |
48 | −6 | 26 | 3.52 | 64 |
||||||||||||
R | Postcentral gyrus |
BA 43 |
68 | −14 | 14 | 4.60 | 177 |
68 | -10 | 16 | 4.25 |
94 |
68 | −14 | 18 | 4.65 |
146 |
R | Precentral gyrus |
BA 6 |
66 | 6 | 20 | 4.06 | 177 |
66 | 8 | 20 | 3.57 |
146 |
|||||
L | S. Temporal gyrus | BA 22/42 |
−68 | −28 | 18 | 3.63 |
64 |
||||||||||
BA 22/42 |
−60 | −34 | 16 | 3.20 | 64 |
||||||||||||
R | S. Temporal gyrus | BA 22/42 |
70 | −22 | 16 | 3.27 | 94 |
||||||||||
BA 22/42 |
72 | −40 | 10 | 3.52 | 17 | ||||||||||||
|
|||||||||||||||||
L | Amygdala |
|
−6 | −6 | −26 | 4.30 | 29 | −6 | −6 | −26 | 3.73 |
35 | |||||
L | Caudate nucleus (anterior part) |
|
−24 | 14 | 18 | 3.53 |
338 |
||||||||||
R | Caudate nucleus (caudal part) |
|
20 | −26 | 20 | 4.56 | 42 |
||||||||||
L | Caudate nucleus (dorsal part) |
|
−26 | −10 | 20 | 4.72 | 203 |
−24 | −4 | 20 | 3.88 |
144 |
−22 | −6 | 20 | 4.90 |
338 |
|
−18 | −4 | 20 | 4.98 | 203 |
−12 | 2 | 18 | 3.96 |
144 |
−14 | 4 | 18 | 4.76 |
338 |
||
R | Caudate nucleus (dorsal part) |
|
22 | 2 | 22 | 4.69 | 229 |
24 | 4 | 20 | 4.84 |
625 |
26 | −4 | 16 | 5.73 |
1201 |
|
24 | −4 | 18 | 4.71 |
625 |
||||||||||||
R | Caudate nucleus(lateral-dorsal part) |
|
32 | −2 | 22 | 4.05 | 229 |
32 | 6 | 20 | 4.74 |
1201 |
|||||
L | Caudate nucleus (tail) |
|
−26 | −36 | 12 | 4.45 | 43 | ||||||||||
R | Putamen |
|
26 | −16 | 16 | 3.90 |
625 |
||||||||||
|
|||||||||||||||||
L | Cerebellar Tonsil (nodule) |
|
−6 | −44 | −34 | 4.73 | 88 | −6 | −46 | −34 | 3.60 |
29 | |||||
R | Nucleus Dentatus |
|
12 | −48 | −30 | 3.48 |
10 | ||||||||||
|
|||||||||||||||||
|
|||||||||||||||||
R | Angular gyrus | BA 39 |
42 | −72 | 34 | 4.16 |
508 |
44 | −62 | 30 | 3.66 | 238 |
|||||
BA 39 |
50 | −66 | 34 | 3.41 | 238 |
||||||||||||
R | Anterior Cingulate gyrus |
BA 32 |
2 | 46 | 6 | 4.94 |
1039 |
||||||||||
R | Cingulate gyrus |
BA 32 |
2 | 18 | 42 | 4.93 |
2140 |
4 | 8 | 50 | 3.24 | 10 | |||||
BA 32 |
8 | 16 | 34 | 3.44 |
18 | ||||||||||||
L | Cingulate sulcus | BA 31 |
−14 | −40 | 40 | 3.91 |
419 |
||||||||||
R | Cingulate sulcus |
BA 6/24 |
16 | −12 | 44 | 5.38 |
2140 |
18 | −12 | 46 | 3.33 | 10 | |||||
L | Cuneus |
BA 18/19 |
−16 | -88 | 32 | 3.82 |
292 |
−16 | -88 | 32 | 3.79 |
577 |
|||||
BA 18/19 |
−10 | −78 | 20 | 3.91 |
292 |
−10 | −78 | 20 | 3.61 |
577 |
|||||||
R | Cuneus |
BA 18/19 |
14 | −78 | 34 | 3.87 |
102 |
12 | −80 | 22 | 3.75 |
184 |
|||||
BA 18/19 |
16 | −90 | 38 | 3.62 |
184 |
||||||||||||
X | Cuneus | BA 18 |
0 | −90 | 40 | 3.77 |
13 | ||||||||||
R | Fusiform gyrus |
BA 19 |
42 | −64 | −20 | 5.00 |
259 |
||||||||||
BA 19/37 |
28 | −58 | −14 | 3.60 |
259 |
||||||||||||
L | I. Frontal gyrus | BA 47 |
−42 | 28 | −12 | 3.67 | 42 | ||||||||||
R | I. Frontal gyrus | BA 45/47 |
46 | 32 | 2 | 3.58 |
11 | ||||||||||
L | Medial Frontal gyrus | BA 10 |
−4 | 66 | 2 | 3.38 | 41 | ||||||||||
L | M. Frontal gyrus | BA 10 |
−20 | 66 | 8 | 3.52 |
9 | ||||||||||
R | S./Medial Frontal gyrus | BA 10 |
12 | 64 | 4 | 4.94 |
1039 |
14 | 64 | 4 | 3.27 | 11 | |||||
BA 10 |
12 | 66 | 12 | 4.75 |
1039 |
||||||||||||
R | S. Frontal gyrus |
BA 8 |
12 | 38 | 56 | 4.81 |
156 |
12 | 36 | 58 | 3.51 | 9 | |||||
BA 6 |
14 | 26 | 66 | 3.38 |
156 |
||||||||||||
L | S. Frontal sulcus |
BA 6 |
−32 | −2 | 48 | 5.47 |
2140 |
−34 | −4 | 50 | 3.60 |
66 |
|||||
BA 6 |
−40 | 4 | 52 | 3.36 |
66 |
||||||||||||
R | S. Frontal sulcus |
BA 4/6 |
26 | −14 | 52 | 3.27 |
26 |
||||||||||
BA 4/6 |
28 | −16 | 44 | 3.61 |
26 |
||||||||||||
L | Lingual gyrus | BA 18 |
−10 | −82 | −10 | 3.23 | 64 |
||||||||||
BA 18 |
−8 | −90 | −10 | 3.50 | 64 |
||||||||||||
R | Lingual gyrus |
BA 18 |
16 | −82 | −14 | 4.31 |
286 |
14 | −80 | −8 | 3.60 | 35 | 14 | −76 | −12 | 3.44 |
32 |
BA 18 |
20 | −72 | −18 | 3.67 |
286 |
||||||||||||
BA 18 |
22 | −74 | −8 | 3.58 |
286 |
||||||||||||
L | M. Occipital gyrus |
BA 18 |
−28 | −88 | 14 | 4.15 |
79 |
||||||||||
BA 18 |
−24 | −98 | 16 | 3.74 |
79 |
||||||||||||
L | S. Occipital gyrus/Angular gyrus |
BA 19/39 |
−38 | −80 | 28 | 6.12 |
299 | −42 | −80 | 32 | 3.68 |
51 | −40 | -80 | 32 | 4.03 |
89 |
R | S. Occipital sulcus |
BA 19 |
30 | −86 | 32 | 3.87 |
508 |
||||||||||
S. Occipital sulcus |
BA 18/19 |
18 | −88 | 40 | 4.03 |
102 |
|||||||||||
R | Occipitotemporal sulcus |
BA 20/37 |
48 | −40 | −12 | 4.66 |
311 |
48 | −40 | −12 | 4.68 |
187 |
44 | −36 | −12 | 4.43 |
134 |
BA 20/37 |
46 | -52 | -6 | 3.74 |
187 |
||||||||||||
L | Parahippocampal gyrus |
BA 35 |
−38 | −44 | -8 | 4.41 |
142 |
||||||||||
BA 35 |
−38 | −42 | −16 | 3.57 |
142 |
||||||||||||
BA 35 |
−26 | −22 | −14 | 3.34 | 10 | ||||||||||||
BA 35 |
−14 | −46 | −2 | 3.49 |
191 |
−8 | −38 | −10 | 5.06 |
426 | |||||||
R | Parahippocampal gyrus |
BA 35/36 |
22 | −44 | −2 | 4.26 |
185 |
||||||||||
BA 35/36 |
24 | −34 | −6 | 4.10 |
185 |
||||||||||||
BA 35/36 |
28 | −42 | −8 | 4.16 |
185 |
||||||||||||
L | Intra-Parietal sulcus |
BA 7/40 |
−34 | −50 | 36 | 4.59 |
419 |
−34 | −48 | 36 | 3.90 |
95 | |||||
BA 7/40 |
−26 | −48 | 40 | 5.50 |
419 |
||||||||||||
R | Intra-Parietal sulcus |
BA 7/40 |
24 | −38 | 44 | 5.53 |
390 |
24 | -40 | 44 | 4.80 |
316 |
|||||
BA 7/40 |
38 | −32 | 34 | 3.69 |
390 |
34 | -36 | 38 | 3.88 |
316 |
|||||||
BA 7/40 |
34 | -28 | 40 | 3.37 |
316 |
||||||||||||
L | Rostral I. Parietal Lobule |
BA 40 |
−58 | −44 | 42 | 4.38 |
87 | ||||||||||
R | S. Parietal lobule |
BA 7 |
26 | −64 | 34 | 5.77 |
508 |
24 | −64 | 36 | 4.01 |
238 |
|||||
L | Precuneus |
BA 7/31 |
−4 | −62 | 32 | 3.96 |
292 |
−8 | −66 | 30 | 4.03 |
577 |
|||||
R | Precuneus | BA 31 |
12 | −62 | 14 | 3.48 |
9 | 12 | -62 | 18 | 3.46 | 61 |
|||||
BA 31 |
16 | -58 | 12 | 3.36 | 61 |
||||||||||||
R | Rectal gyrus | BA 11 |
2 | 28 | −14 | 4.10 |
126 | ||||||||||
L | M. Temporal gyrus | BA 21 |
−52 | −24 | −8 | 4.14 |
124 | ||||||||||
R | M. Temporal gyrus |
BA 21 |
54 | −26 | −12 | 4.62 |
311 |
54 | −26 | −12 | 3.40 |
187 |
|||||
BA 21 |
62 | −8 | −12 | 4.25 |
311 |
||||||||||||
|
|||||||||||||||||
L | Caudatus nucleus (head) |
|
−6 | 6 | 0 | 4.43 |
66 | −8 | 4 | −2 | 3.39 |
13 | |||||
R | Lateral Globus Pallidus |
|
16 | 4 | −2 | 3.51 |
160 |
16 | 6 | −2 | 3.47 |
118 |
|||||
|
20 | -6 | −6 | 3.57 |
118 |
||||||||||||
|
24 | 0 | −2 | 4.25 |
160 |
24 | 0 | −2 | 3.36 |
118 |
|||||||
R | Substania Nigra |
|
8 | −18 | −10 | 3.45 | 16 | ||||||||||
R | Thalamus |
|
8 | −8 | 0 | 4.19 |
160 |
||||||||||
|
|||||||||||||||||
L | Cerebellum (anterior lobe) |
|
−4 | −40 | −12 | 4.84 |
191 |
Overview of brain areas with statistically significant cerebral blood flow changes when comparing DID patients to high or low DID simulating controls (CH and CL respectively) for the dissociative identity state main effects.
DID = dissociative identity disorder patient group.
CH = high fantasy prone DID simulating control group.
CL = low fantasy prone DID simulating control group.
=
= Brain areas found only in the DID within group analysis.
= Brain areas found in the DID within group analysis, in the DID versus CH between group analysis
= Brain areas found in the DID within group analysis
= Brain areas found in the DID within group analysis
= Brain areas not found in the DID within group analysis
= first peak voxel in the cluster of the specified size.
= second peak voxel in the cluster of the specified size.
= third peak voxel in the cluster of the specified size.
= whole brain multiple comparison correction (
= region of interest multiple comparison correction (
= Callosomarginal sulcus (SCM) ( = Cingulate sulcus).
= Supramarginal gyrus (Rostral I. Parietal Lobule).
(x, y, z) = MNI coordinates in mm.
L/R = Left/Right.
kE = clustersize in voxels (one voxel is 2×2×2 mm).
NIS = neutral identity state.
TIS = trauma-related identity state.
BA = Brodmann area.
I. = inferior; M. = middle; S. = superior.
Results for the within DID group re-analyses and for the two between group comparisons of the dissociative identity states (DIS) main effects, both TIS and NIS, are given in
See
Trauma-related MS effects within both TIS and NIS are given in
|
|
|||||||||||||||||
DID only | DID - CH | DID - CL | ||||||||||||||||
L/R | Brain Region |
BA | x | y | z | T | kE | x | y | z | T | kE | x | y | z | T | kE | |
|
||||||||||||||||||
|
||||||||||||||||||
L | Insula |
BA 13 |
−46 | −20 | 14 | 5.32 | 569 |
|||||||||||
BA 13 |
−38 | −14 | 14 | 4.36 | 569 |
−38 | −14 | 14 | 3.61 |
48 |
−38 | −14 | 14 | 4.61 |
327 |
|||
L | Parietal operculum |
BA 40 |
−48 | −30 | 12 | 4.02 | 569 |
−50 | −22 | 12 | 3.39 |
327 |
||||||
R | Postcentral gyrus | BA 43 |
68 | −14 | 18 | 3.58 | 19 | |||||||||||
R | I. Temporal gyrus | BA 20 |
32 | −12 | −44 | 3.57 | 9 | |||||||||||
L | S. Temporal gyrus | BA 42 |
−68 | −28 | 14 | 3.51 | 95 |
|||||||||||
BA 22 |
−58 | −40 | 12 | 3.73 | 95 |
|||||||||||||
|
||||||||||||||||||
L | Amygdala |
|
−10 | −6 | −24 | 4.18 | 63 | −12 | −4 | −26 | 4.05 |
132 | ||||||
L | Caudate nucleus (dorsal part) |
|
−12 | 4 | 16 | 4.13 |
39 | |||||||||||
R | Caudate nucleus (dorsal part) |
|
22 | 0 | 22 | 4.05 | 28 | 24 | −2 | 14 | 3.64 |
53 |
26 | 2 | 20 | 3.76 |
56 | |
R | Caudate nucleus(lateral-dorsal part) |
|
28 | 6 | 14 | 3.18 |
53 |
|||||||||||
L | Caudate nucleus (tail) |
|
−24 | −34 | 16 | 4.36 | 20 | −22 | −24 | 16 | 3.60 |
13 | ||||||
R | Caudate nucleus (tail) |
|
36 | −38 | 10 | 3.80 | 24 | |||||||||||
L | Putamen |
|
−24 | −18 | 14 | 3.30 | 48 |
−24 | −18 | 14 | 3.22 | 327 |
||||||
|
||||||||||||||||||
L | Cerebellar Tonsil (nodule) |
|
−6 | −42 | −34 | 4.07 | 34 | |||||||||||
|
||||||||||||||||||
|
||||||||||||||||||
R | Angular gyrus | BA 39 |
48 | −74 | 32 | 3.30 | 11 | |||||||||||
L | Anterior Cingulate gyrus | BA 32 |
−2 | 44 | 8 | 3.61 | 14 | |||||||||||
L | Posterior Cingulate gyrus |
BA 31 |
−8 | −38 | 46 | 3.78 | 11 | |||||||||||
R | Cingulate sulcus |
BA 6/24 |
20 | −10 | 52 | 4.02 | 116 |
20 | −10 | 52 | 3.76 |
101 | ||||||
BA 6/24 |
14 | −12 | 46 | 3.90 | 116 |
|||||||||||||
L | Cuneus |
BA 18/19 |
−10 | −78 | 24 | 3.81 | 177 |
−10 | −78 | 24 | 3.39 |
210 |
||||||
R | Cuneus | BA 18/19 |
16 | −84 | 28 | 3.41 | 64 |
|||||||||||
R | I. Frontal gyrus | BA 44 |
56 | 10 | 2 | 3.69 | 18 | |||||||||||
R | Fusiform gyrus |
BA 19/37 |
26 | −56 | −14 | 4.11 | 345 |
26 | −58 | −18 | 3.77 |
478 |
||||||
BA 18 |
26 | −96 | −20 | 3.48 | 38 |
|||||||||||||
BA 19/37 |
36 | −56 | −20 | 3.80 | 345 |
34 | −58 | −20 | 4.11 | 478 |
||||||||
BA 19/37 |
38 | −66 | −24 | 4.65 | 345 |
|||||||||||||
L | Lingual gyrus | BA 18 |
−14 | −88 | −14 | 3.73 | 139 |
|||||||||||
BA 18 |
−10 | −82 | −10 | 3.23 | 139 |
|||||||||||||
R | Lingual gyrus | BA 18 |
22 | −72 | −22 | 4.09 | 478 |
|||||||||||
BA 18 |
24 | −100 | −10 | 3.65 | 38 |
|||||||||||||
L | S. Occipital gyrus |
BA 19/39 |
−40 | −80 | 26 | 4.19 | 39 | −42 | −80 | 28 | 3.59 | 29 | ||||||
R | S. Occipital gyrus |
BA 19 |
30 | −84 | 30 | 3.96 | 26 | |||||||||||
R | S. Occipital sulcus |
BA 18/19 |
18 | −90 | 38 | 3.86 | 64 |
|||||||||||
R | Occipitotemporal sulcus |
BA 20/37 |
48 | −34 | −16 | 3.96 | 34 |
48 | −38 | −12 | 3.65 | 23 | 46 | −36 | −14 | 4.31 |
89 | |
L | Parahippocampal gyrus | BA 35/36 |
−24 | −34 | −14 | 3.61 | 23 | |||||||||||
L | Intra-Parietal sulcus |
BA 7/40 |
−38 | −52 | 32 | 3.99 | 27 | |||||||||||
BA 7/40 |
−22 | −48 | 34 | 3.81 | 14 | |||||||||||||
R | Intra-Parietal sulcus |
BA 7/40 |
28 | −38 | 44 | 4.54 | 110 |
|||||||||||
BA 7/40 |
38 | −36 | 36 | 3.37 | 110 |
34 | −36 | 36 | 3.72 |
62 | 34 | −34 | 38 | 4.13 |
122 | |||
L | Rostral I. Parietal Lobule |
BA 40 |
−60 | −44 | 40 | 3.77 | 19 | |||||||||||
R | S. Parietal Lobule/Precuneus |
BA 7 |
24 | −64 | 36 | 4.32 | 65 | 28 | −66 | 32 | 3.49 |
34 | ||||||
L | Precentral sulcus |
BA 4/6 |
−30 | −8 | 52 | 3.85 | 43 | |||||||||||
L | Precuneus |
BA 7/31 |
−16 | −68 | 28 | 4.22 | 177 |
−12 | −66 | 26 | 4.25 |
210 |
−16 | −68 | 28 | 4.26 |
181 | |
BA 7/31 |
−10 | −64 | 32 | 3.74 | 177 |
|||||||||||||
R | (Pre-)Cuneus/Parieto-occipital sulcus | BA 7/19 |
18 | −78 | 34 | 3.79 | 64 |
|||||||||||
R | M. Temporal gyrus |
BA 21 |
54 | −26 | −12 | 3.58 | 34 |
|||||||||||
BA 21 |
62 | −6 | −14 | 4.24 | 48 | 60 | −2 | −16 | 3.33 | 11 | ||||||||
|
||||||||||||||||||
L | Cerebellum (anterior lobe) |
|
−4 | −42 | −14 | 3.79 | 11 | −4 | −44 | −14 | 3.62 | 48 |
||||||
|
−4 | −36 | −12 | 3.43 | 48 |
Overview of brain areas with statistically significant cerebral blood flow changes when comparing DID patients to high or low DID simulating controls (CH and CL respectively) for the trauma-related memory script effects within dissociative identity state.
DID = dissociative identity disorder patient group.
CH = high fantasy prone DID simulating control group.
CL = low fantasy prone DID simulating control group.
=
= Brain areas found only in the DID within group analysis.
= Brain areas found in the DID within group analysis, in the DID versus CH between group analysis
= Brain areas found in the DID within group analysis
= Brain areas found in the DID within group analysis
= Brain areas not found in the DID within group analysis
= first peak voxel in the cluster of the specified size.
= second peak voxel in the cluster of the specified size.
= third peak voxel in the cluster of the specified size.
= whole brain multiple comparison correction (
= region of interest multiple comparison correction (
= Callosomarginal sulcus (SCM) ( = Cingulate sulcus).
= Supramarginal gyrus (Rostral I. Parietal Lobule).
(x, y, z) = MNI coordinates in mm.
L/R = Left/Right.
kE = clustersize in voxels (one voxel is 2×2×2 mm).
NISn = neutral identity state exposed to the neutral memory script.
NISt = neutral identity state exposed to the trauma-related memory script.
TISn = trauma-related identity state exposed to the neutral memory script.
TISt = trauma-related identity state exposed to the trauma-related memory script.
BA = Brodmann area.
I. = inferior; M. = middle; S. = superior.
Trauma-related MS effects between DIS are given in
Differences in regional cerebral blood flow patterns for the dissociative identity disorder (DID) group (left) and the comparison of this group to the high (middle) and low (right) fantasy prone DID simulating controls (CH and CL respectively) are depicted. See
|
|
|||||||||||||||||||||||||||||||||
DID only | DID - CH | DID - CL | ||||||||||||||||||||||||||||||||
L/R | Brain region |
BA | x | y | z | T | kE | x | y | z | T | kE | x | y | z | T | kE | |||||||||||||||||
|
||||||||||||||||||||||||||||||||||
|
||||||||||||||||||||||||||||||||||
L | Insula |
BA 13 |
−46 | −20 | 14 | 5.32 | 367 |
−42 | −20 | 16 | 4.10 |
568 |
||||||||||||||||||||||
BA 13 |
−34 | −16 | 16 | 3.65 | 367 |
|||||||||||||||||||||||||||||
R | Insula | BA 13 |
42 | −6 | 26 | 3.26 | 37 |
|||||||||||||||||||||||||||
BA 13 |
46 | −12 | 26 | 3.41 | 16 | |||||||||||||||||||||||||||||
L | Orbitofrontal cortex | BA 11 |
−32 | 36 | −22 | 3.58 | 21 | |||||||||||||||||||||||||||
R | Parietal operculum | BA 40/43 |
48 | −2 | 22 | 3.40 | 37 |
|||||||||||||||||||||||||||
R | Postcentral gyrus |
BA 43 |
68 | −14 | 14 | 3.83 | 23 | 68 | −14 | 14 | 3.44 | 12 | 68 | −14 | 18 | 4.45 |
106 | |||||||||||||||||
R | Precentral gyrus | BA 6 |
66 | 8 | 20 | 3.87 | 41 | |||||||||||||||||||||||||||
L | S. Temporal gyrus | BA 22/42 |
−68 | −28 | 14 | 3.81 | 92 |
|||||||||||||||||||||||||||
BA 22 |
−58 | −40 | 14 | 3.45 | 92 |
|||||||||||||||||||||||||||||
|
||||||||||||||||||||||||||||||||||
L | Amygdala |
|
−16 | −12 | −32 | 3.34 |
129 |
|||||||||||||||||||||||||||
|
−6 | −6 | −26 | 4.06 | 24 | −6 | −6 | −26 | 3.75 |
129 |
||||||||||||||||||||||||
R | Caudate nucleus (caudal part) |
|
20 | −26 | 20 | 4.01 | 10 | 20 | −24 | 18 | 3.75 |
352 |
||||||||||||||||||||||
L | Caudate nucleus (dorsal part) |
|
−26 | −10 | 20 | 4.07 | 78 |
−26 | −10 | 20 | 3.49 |
29 |
−26 | −4 | 20 | 4.02 |
568 |
|||||||||||||||||
|
−12 | 2 | 18 | 4.04 | 78 |
−12 | 2 | 18 | 3.90 |
34 | −12 | 4 | 16 | 4.71 |
568 |
|||||||||||||||||||
R | Caudate nucleus (dorsal part) |
|
24 | −2 | 14 | 4.38 |
352 |
26 | 0 | 18 | 5.09 |
490 |
||||||||||||||||||||||
|
22 | 2 | 22 | 4.29 | 61 | 24 | 4 | 20 | 4.37 |
352 |
||||||||||||||||||||||||
L | Caudate nucleus (tail) |
|
−24 | −34 | 16 | 4.12 | 19 | |||||||||||||||||||||||||||
L | Putamen |
|
−24 | −18 | 14 | 3.55 | 29 |
|||||||||||||||||||||||||||
R | Putamen |
|
26 | −14 | 16 | 3.66 | 490 |
|||||||||||||||||||||||||||
|
||||||||||||||||||||||||||||||||||
L | Cerebellar Tonsil (nodule) |
|
−8 | −56 | −34 | 3.25 |
47 |
|||||||||||||||||||||||||||
|
−6 | −44 | −34 | 4.81 | 84 | −6 | −46 | −34 | 3.63 | 47 |
||||||||||||||||||||||||
L | Cerebellum (lateral part) |
|
−56 | −48 | −32 | 4.03 | 24 |
|||||||||||||||||||||||||||
|
−54 | −48 | −42 | 3.41 | 24 |
|||||||||||||||||||||||||||||
|
||||||||||||||||||||||||||||||||||
|
||||||||||||||||||||||||||||||||||
R | Angular gyrus | BA 39 |
48 | −64 | 32 | 4.03 |
597 |
44 | −62 | 30 | 3.80 | 135 |
46 | −62 | 34 | 3.34 | 11 | |||||||||||||||||
BA 39 |
50 | −66 | 34 | 3.44 | 135 |
|||||||||||||||||||||||||||||
L | Anterior Cingulate gyrus | BA 32 |
−2 | 38 | 10 | 3.62 |
142 |
|||||||||||||||||||||||||||
BA 32 |
−4 | 54 | 10 | 3.34 |
142 |
|||||||||||||||||||||||||||||
X | Anterior Cingulate gyrus |
BA 32 |
0 | 46 | 6 | 4.21 |
142 |
|||||||||||||||||||||||||||
L | Cingulate gyrus |
BA 24 |
−10 | −12 | 38 | 3.96 |
40 | |||||||||||||||||||||||||||
R | Cingulate gyrus |
BA 32 |
2 | 18 | 42 | 4.64 |
376 |
8 | 14 | 36 | 3.74 |
89 |
||||||||||||||||||||||
BA 32 |
6 | 8 | 48 | 3.80 |
376 |
4 | 8 | 50 | 3.28 |
89 |
||||||||||||||||||||||||
L | Cingulate sulcus/Cingulate gyrus |
BA 24/32 |
−16 | 12 | 44 | 4.10 |
376 |
|||||||||||||||||||||||||||
R | Cingulate sulcus |
BA 6/24 |
16 | −12 | 44 | 4.91 |
614 |
20 | −10 | 46 | 3.53 |
72 |
||||||||||||||||||||||
BA 6/24 |
20 | −10 | 52 | 4.51 |
614 |
|||||||||||||||||||||||||||||
L | Posterior Cingulate gyrus | BA 31 |
−6 | −42 | 40 | 3.37 | 14 | |||||||||||||||||||||||||||
L | Cuneus |
BA 18/19 |
−10 | −78 | 20 | 4.57 |
620 |
−10 | −78 | 20 | 4.08 |
921 |
−12 | −72 | 30 | 3.64 |
92 |
|||||||||||||||||
BA 18/19 |
−14 | −72 | 30 | 4.17 |
620 |
−14 | −76 | 32 | 3.92 |
921 |
−16 | −90 | 36 | 3.56 |
20 | |||||||||||||||||||
R | Cuneus |
BA 18/19 |
16 | −84 | 28 | 3.83 |
212 |
12 | −80 | 22 | 3.86 |
252 |
||||||||||||||||||||||
BA 19 |
18 | −80 | 36 | 3.99 |
212 |
18 | −90 | 38 | 3.80 |
252 |
||||||||||||||||||||||||
BA 19 |
18 | −84 | 30 | 3.52 |
252 |
|||||||||||||||||||||||||||||
X | Cuneus | BA 18 |
0 | −90 | 40 | 3.61 |
19 | |||||||||||||||||||||||||||
L | I. Frontal gyrus | BA 47 |
−42 | 28 | −12 | 3.42 | 19 | |||||||||||||||||||||||||||
R | S. Frontal gyrus |
BA 10 |
22 | 66 | 16 | 4.03 |
407 |
|||||||||||||||||||||||||||
BA 8 |
12 | 38 | 56 | 4.83 |
177 |
|||||||||||||||||||||||||||||
BA 6 |
14 | 26 | 66 | 3.40 |
177 |
|||||||||||||||||||||||||||||
R | S./Medial Frontal gyrus |
BA 10 |
12 | 64 | 4 | 4.59 |
407 |
|||||||||||||||||||||||||||
R | BA 10 |
10 | 64 | 20 | 4.02 |
407 |
||||||||||||||||||||||||||||
L | S. Frontal sulcus |
BA 6 |
−32 | −2 | 48 | 5.02 |
318 | −34 | −2 | 52 | 3.64 | 36 | ||||||||||||||||||||||
R | S. Frontal sulcus |
BA 4/6 |
26 | −14 | 52 | 3.32 |
33 |
24 | −10 | 56 | 3.44 |
72 |
||||||||||||||||||||||
BA 4/6 |
28 | −14 | 46 | 4.56 |
614 |
28 | −16 | 44 | 3.61 |
33 |
||||||||||||||||||||||||
L | Fusiform gyrus | BA 19 |
−28 | −68 | −10 | 3.47 | 28 | |||||||||||||||||||||||||||
R | Fusiform gyrus |
BA 18 |
26 | −96 | −20 | 3.34 |
34 |
|||||||||||||||||||||||||||
BA 19/37 |
26 | −56 | −14 | 4.10 |
149 |
|||||||||||||||||||||||||||||
BA 19 |
40 | −78 | −22 | 3.38 |
185 |
|||||||||||||||||||||||||||||
BA 19/37 |
42 | −64 | −20 | 4.79 |
185 |
38 | −62 | −20 | 3.79 |
482 |
||||||||||||||||||||||||
L | Lingual gyrus | BA 18 |
−10 | −84 | −14 | 3.88 |
616 |
|||||||||||||||||||||||||||
BA 18 |
−6 | −82 | −6 | 3.91 |
616 |
|||||||||||||||||||||||||||||
BA 18 |
−4 | −90 | −10 | 4.33 |
616 |
|||||||||||||||||||||||||||||
R | Lingual gyrus | BA 18 |
20 | −72 | −14 | 3.68 |
26 | 18 | −98 | −14 | 3.20 | 34 |
||||||||||||||||||||||
L | M. Occipital gyrus |
BA 18 |
−30 | −92 | 12 | 3.99 |
364 |
|||||||||||||||||||||||||||
BA 18 |
−24 | −98 | 16 | 3.73 |
364 |
|||||||||||||||||||||||||||||
L | S. Occipital gyrus |
BA 19/39 |
−38 | −80 | 28 | 5.61 |
364 |
−38 | −82 | 30 | 3.72 |
82 | −42 | −78 | 32 | 4.27 |
128 | |||||||||||||||||
R | S. Occipital gyrus | BA 19 |
30 | −84 | 30 | 4.02 |
597 |
|||||||||||||||||||||||||||
R | S. Occipital sulcus |
BA 18/19 |
18 | −90 | 38 | 4.35 |
212 |
|||||||||||||||||||||||||||
R | Occipitotemporal sulcus |
BA 20/37 |
46 | −34 | −14 | 4.39 |
327 |
48 | −40 | −12 | 4.53 |
92 | 46 | −36 | −14 | 5.24 |
294 |
|||||||||||||||||
L | Parahippocampal gyrus |
BA 35 |
−40 | −46 | −4 | 3.75 | 18 | −40 | −46 | −6 | 4.73 |
780 |
||||||||||||||||||||||
BA 35/36 |
−12 | −42 | −6 | 3.59 |
70 |
−24 | −34 | −14 | 4.02 |
780 |
||||||||||||||||||||||||
R | Parahippocampal gyrus |
BA 36 |
20 | −52 | 2 | 3.46 |
52 |
22 | −52 | 0 | 4.26 |
482 |
||||||||||||||||||||||
BA 35/36 |
20 | −46 | −2 | 4.03 |
149 |
22 | −42 | −6 | 3.77 |
482 |
||||||||||||||||||||||||
BA 35/36 |
24 | −34 | −6 | 3.98 |
149 |
|||||||||||||||||||||||||||||
L | Intra-Parietal sulcus |
BA 7/40 |
−38 | −52 | 32 | 4.96 |
426 |
−34 | −50 | 34 | 4.36 |
117 | ||||||||||||||||||||||
BA 7/40 |
−22 | −48 | 34 | 5.25 |
426 |
|||||||||||||||||||||||||||||
BA 7/40 |
−22 | −36 | 38 | 4.53 |
426 |
|||||||||||||||||||||||||||||
R | Intra-Parietal sulcus |
BA 7/40 |
28 | −38 | 44 | 5.07 |
332 |
|||||||||||||||||||||||||||
BA 7/40 |
34 | −36 | 38 | 4.15 |
332 |
30 | −38 | 40 | 4.36 |
249 | 34 | −34 | 38 | 3.52 | 30 | |||||||||||||||||||
L | Rostral I. Parietal lobule |
BA 40 |
−58 | −44 | 42 | 4.00 |
52 | |||||||||||||||||||||||||||
R | S. Parietal lobule/Precuneus |
BA 7 |
26 | −64 | 32 | 5.61 |
597 |
24 | −64 | 30 | 3.95 |
108 | 24 | −64 | 36 | 3.80 |
48 | |||||||||||||||||
L | Precuneus |
BA 7/31 |
−6 | −62 | 30 | 3.85 |
620 |
−8 | −66 | 26 | 4.72 | 921 |
−10 | −64 | 32 | 3.53 |
92 |
|||||||||||||||||
R | Precuneus | BA 31 |
14 | −64 | 16 | 3.25 | 52 |
|||||||||||||||||||||||||||
BA 31 |
16 | −54 | 12 | 3.42 | 52 |
|||||||||||||||||||||||||||||
X | Rectal gyrus | BA 11 |
0 | 28 | −12 | 3.82 |
85 | |||||||||||||||||||||||||||
L | M. Temporal gyrus | BA 21 |
−54 | −24 | −10 | 3.71 |
63 | |||||||||||||||||||||||||||
R | M. Temporal gyrus |
BA 21 |
62 | −6 | −14 | 4.80 |
327 |
62 | −6 | −14 | 3.64 | 15 | 62 | −6 | −14 | 4.16 |
120 | |||||||||||||||||
BA 21 |
54 | −26 | −12 | 4.24 |
327 |
54 | −24 | −10 | 3.66 |
294 |
||||||||||||||||||||||||
|
||||||||||||||||||||||||||||||||||
L | Caudatus nucleus (head) |
|
−6 | 8 | −2 | 3.94 |
15 | |||||||||||||||||||||||||||
R | Lateral Globus Pallidus |
|
24 | −8 | −8 | 3.77 |
85 |
|||||||||||||||||||||||||||
|
24 | 0 | −2 | 4.13 |
70 |
24 | 0 | −2 | 3.34 |
85 |
||||||||||||||||||||||||
R | Medial Globus Pallidus |
|
14 | −6 | −2 | 3.44 |
70 |
|||||||||||||||||||||||||||
|
||||||||||||||||||||||||||||||||||
L | Cerebellum (anterior lobe) |
|
−6 | −42 | −12 | 4.23 |
70 |
−4 | −42 | −12 | 4.53 |
780 |
Overview of brain areas with statistically significant cerebral blood flow changes when comparing DID patients to high or low DID simulating controls (CH and CL respectively) for the trauma-related memory script effects between dissociative identity state.
DID = dissociative identity disorder patient group.
CH = high fantasy prone DID simulating control group.
CL = low fantasy prone DID simulating control group.
=
= Brain areas found only in the DID within group analysis.
= Brain areas found in the DID within group analysis, in the DID versus CH between group analysis
= Brain areas found in the DID within group analysis
= Brain areas found in the DID within group analysis
= Brain areas not found in the DID within group analysis
= first peak voxel in the cluster of the specified size.
= second peak voxel in the cluster of the specified size.
= third peak voxel in the cluster of the specified size.
= whole brain multiple comparison correction (
= region of interest multiple comparison correction (
= Callosomarginal sulcus (SCM) ( = Cingulate sulcus).
= Supramarginal gyrus (Rostral I. Parietal Lobule).
(x, y, z) = MNI coordinates in mm.
L/R = Left/Right.
kE = clustersize in voxels (one voxel is 2×2×2 mm).
NISn = neutral identity state exposed to the neutral memory script.
NISt = neutral identity state exposed to the trauma-related memory script.
TISn = trauma-related identity state exposed to the neutral memory script.
TISt = trauma-related identity state exposed to the trauma-related memory script.
BA = Brodmann area.
I. = inferior; M. = middle; S. = superior.
The present study was performed to examine whether earlier reported results
Differences in regional cerebral bloodflow patterns for the dissociative identity disorder (DID) group (left) and the comparison of this group to the high (middle) and low (right) fantasy prone DID simulating controls (CH and CL respectively) are depicted. See
These areas involve the most significant rCBF difference between the dissociative identity disorder patients and high and low fantasy prone DID simulating controls (CH and CL respectively) and is shown in both directionality, i.e. the bar graphs, and location, i.e. shown on a coronal overlay (left in the picture is left in the brain). Results show the differential processing of the trauma-related text between the TIS and the NIS, when comparing the DID groups to the high fantasy prone control group (left) and low fantasy prone control group (right).
From results shown in
The activated areas seem to be subdivided in two distinct neural networks, where the NIS activates areas in the cerebral cortex, while the TIS mainly activates subcortical areas (e.g., see
Our findings support the cortico-limbic inhibition model of trauma-related dissociative disorders
There are notable similarities in the patterns of brain activation for DID patients, as revealed in the main effect TIS and the TISt-NISt comparison, and mentally healthy individuals unsuppressed memory retrieval
To date, experimental research of inter-identity amnesia in DID has produced mixed results. One study
The sociocognitive view of DID entails the idea that this disorder can be easily and readily created in motivated suggestible individuals and that few suggestions would suffice to generate the symptoms of DID
For the first time, it is shown using brain imaging that neither high nor low fantasy prone healthy women, who enacted two different types of dissociative identity states, were able to substantially simulate these identity states in psychobiological terms. These results do not support the idea of a sociogenic origin for DID.
Mentally healthy females were recruited by local newspaper advertisements. Respondents were sent a letter in which the study was explained and in which they were invited to complete three questionnaires: (i) the Traumatic Experiences Checklist (TEC)
After inclusion, written and oral information on dissociative identity states (i.e. NIS and TIS) in DID and instructions on how to simulate these dissociative identity states was given to the controls. It was checked whether the controls understood this information. A template for training themselves in switching between the simulated identity states was provided. Controls were then questioned about how they constructed the two identity states, whether they encountered difficulties and if so, they were given support to improve their roles as NIS and TIS. To help the controls simulate NIS and TIS, they were asked to recall two experiences they had had earlier in their life, an emotionally neutral experience and an emotionally painful experience. Controls were asked to provide their most painful memory to serve as an analogue for the patients’ personal trauma memories, as well as a neutral personal episodic memory. Controls were subsequently instructed how to write the autobiographical analogue neutral and “trauma” memory scripts. For the experiment they had to train themselves in being in a neutral state, the NIS who is unresponsive or under-responsive to the painful experience, and in being in a state in which they re-experience the painful memory, the TIS. The consecutive and final check on the capability to simulate the two different dissociative identity states consisted in checking whether their description of their neutral and painful experiences (that was to be casted in an audiotape recording) met the instructions on how to enact a DID patient.
In the two or more weeks preceding the PET scans, candidate control subjects practiced simulating NIS and TIS, as well as alternating between NIS and TIS using detailed role instructions. One of the investigators (H.V.) contacted the candidates per telephone during this preparatory phase to ensure that they followed the instructions and to offer further suggestions for optimizing their role performance. One candidate felt unable to simulate the roles satisfactorily, and was therefore excluded. Prior to the actual PET scanning, H.V. checked if the candidates experienced and judged that they were able to simulate the roles of NIS and TIS. During the actual scanning, he checked if they engaged in the requested simulations, and immediately after the role performances, he checked if the controls generally felt they had simulated the roles of NIS and TIS effectively. All controls passed these various checks. In addition, immediately after each text condition, H.V. administered a detailed questionnaire that inquired after the controls’ subjective sensorimotor and emotional experiences during their role performance. This questionnaire was identical to the one in the patient study
As we did not have CEQ values for the patients (see also
A detailed description of the DID patients can be found elsewhere
To establish the CEQ values in DID patients an independent and representative sample of DID patients (n = 42) completed the CEQ. Details regarding this substudy can be found in the
During scanning, patients and controls listened to descriptions of the neutral episodic memories and memories of traumatizing or most painful events that only TIS experienced as a personal memory
The PET (Siemens/CTI ECAT HR+) procedure for the controls was close to identical to the patients
For the controls one extra set of the four conditions was added to increase statistical power. The scanning sequence was therefore NISn, NISt, TISn, TISt, TISn, TISt, NISn, NISt, TISn, TISt, NISn and NISt. The last minor character (n or t) denotes the content of the memory script (MS: neutral or trauma-related). For patient comfort considerations, i.e. minimizing the number of identity state switches, a fixed condition order was used, which was also used for the controls to minimize methodological differences.
Immediately following the end of each script, blood pressure (systolic and diastolic) and discrete heart rate frequency were measured and the six subjective emotional and ten sensorimotor experiences were debriefed. Finally, the presence of the identity state under investigation and the interference among identity states were also debriefed.
Data acquisition, reconstruction, attenuation correction, spatial transformation, spatial smoothing (isotropic Gaussian kernel of 12 mm) and global normalization were performed as usual
Statistical analysis, missing value analysis and principal components (PC) analysis were performed with SPSS-PC 15.0 (2006) in an identical manner as was done for the patient data
The patient PET data included in the current study is identical to the data as included and described in our previous publications
From the 10 high fantasy prone healthy controls the PET data of one subject was lost due to storage failure at the PET center. The data of the three groups was statistically analyzed in SPM5 in a three-by-two-by-two factorial design
In addition, the subjective reactions and the autonomic reactions were included as group specific covariates of interest after PC analysis
Previously reported significant findings were tested using a between group subtraction of the within group results (e.g. DID(TISt-NISt)-Control(TISt-NISt)). Commonalities in brain activation between patients and controls were tested using global null conjunction analyses
Our
The coordinates were converted from MNI space to Talairach space
Fantasy proneness in dissociative identity disorder.
(DOC)
How well are the dissociative identity disorder simulating healthy controls doing?
(DOC)
The authors are greatly indebted to all the participants: thank you for participating. They also would like to thank Margo Jongsma for her assistance and participant recruitment. Jaap Haaksma is thanked for the HRV data collection and Marc van Ekeren for help during data collection and pilot analyses. Finally, Borden Armstrong is thanked for psychophysiological data-analysis support and proof reading.