A review of the published neurological research implicates different bilateral and particularly temporolimbic abnormalities in the mechanisms of dissociation and depersonalization. Further research employing technologically advanced high resolution imaging and larger samples is needed to clarify and enhance the current evidence.
A review of the published neurological research implicates different bilateral and particularly temporolimbic abnormalities in the mechanisms of dissociation and depersonalization. Further research employing technologically advanced high resolution imaging and larger samples is needed to clarify and enhance the current evidence.
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A review of the published neurological research implicates different bilateral and particularly temporolimbic abnormalities in the mechanisms of dissociation and depersonalization. Further research employing technologically advanced high resolution imaging and larger samples is needed to clarify and enhance the current evidence.
Direitos autorais:
Attribution Non-Commercial (BY-NC)
Formatos disponíveis
Baixe no formato PDF, TXT ou leia online no Scribd
Dissociative Identity Disorder and the Brain: A Brief
Review
Alysa Beth Ray, Amanda Johnson, Sean O’Hagen, Gina Lardi,
and Julian Paul Keenan Montclair State University Dissociative identity and depersonalization disorders are characterized by disruptions in the experience of self. Understanding the brain functions involved in these disorders is important to understanding the processes of self-experience in the human brain. A review of the published neurological research implicates different bilateral and particularly temporolimbic abnormalities in the mechanisms of dissociation and depersonalization. Further research employing technologically advanced high resolution imaging and larger samples is needed to clarify and enhance the current evidence.
Disociative disorders are reality testing is maintained in
marked by disruptions of memory, individuals with DPD. consciousness, identity, and the In manifestations of both DID perceived environment. and DPD seen in patients Dissociative identity (DID) and following mild traumatic brain depersonalization disorders (DPD) injury, CT scans and relate particularly to electroencephalogram (EEG) showed dysfunctions in one’s sense of no evidence of focal lesions, self. In DID this is categorized while single-photon emission by a splitting of the elements of computerized tomography (SPECT) the self into two or more did show some bilateral personality states within one abnormalities suggesting diffuse individual (American Psychiatric cerebral hypofusion (Grigsby 1986 Association, Diagnostic and and Cantagallo, Grassi, & Della Statistical Manual-IV, 1994). Sala, 1999). In both cases some These distinct identities left hemispheric dysfunction is recurrently control the suggested in one participant’s individual’s behavior, displaying poor verbal performance (Grigsby) their own separate patterns of and in another participant’s perceptions and thoughts in SPECT results (Cantagallo et relation to themselves and their al.). More specific localization environment, often in contrast may have appeared with the use of with the characteristics of the higher resolution technology such primary identity. As a result, as magnetic resonance imaging individuals with DID experience (MRI). In an early study by memory gaps of events and Coons, Milstein, and Marley situations throughout their (1982), EEG of two DID patients lives. In DPD, individuals and their alter states showed experience recurrent or differences in right hemisphere persistent feelings of detachment recordings. When the control from their body or their mental participant simulated different processes. This is often affectations, the EEG results accompanied by derealization, a showed even greater differences sense that the world outside is in right hemisphere recordings. unreal or strange to them. In The researchers commented that contrast to schizophrenia, intact their results suggest that 12 IDENTITY DISORDER BRAIN CORRELATES differences in personality states consistent with multiple in DID are based on changes in personalities, and 5 suffered affect and concentration, such as illusions of possession (Mesulam, the control manifested in his 1981). Lee, Loring, Meador, simulations, rather than on Flanigin and Brooks (1988) used inherent brain differences. the intracarotid amobarbital However, because the readings sodium procedure (IAP) on 92 from the control participant participants and reported that of reflected greater changes than those 92 tested, all five who the readings from the DID displayed severe behavioral participants, it seems that responses from right hemispheric inherent brain function inactivation had structural differences may actually have lesions in their left hemisphere. played a role. Further studies Also using IAP Ahern, Herring, with EEG and higher resolution Tackenberg, Seeger, Oommen, technology have shown such Labiner, et al. (1993) studied differences in DID and DPD two participants with left participants. Abnormalities in temporolimbic epilepsy. Through the left hemisphere, particularly IAP they were able to replicate temporal, are implicated in much the ictal and postictal altered of the research in DID and DPD. personality states that had been Hollander and colleagues (1992) reported previously by the studied a participant with DPD patients and their families. using brain electrical mapping Both of the participants’ alter (BEAM). The results suggested shifts were induced by some diffuse dysfunction, but inactivation of the left more so in the left temporal hemisphere, with no EEG evidence areas, which had a prominent of seizure activity at the time. increase in evoked potential In one of these participants, his negativities as well as in theta previously reported preictal and anteriorized alpha altered state---delusions - of being activities. Although MRI of the Jesus imprisoned in Hell---was - participant’s brain was within induced by right hemisphere normal limits, SPECT demonstrated inactivation. One implication is dysfunctional perfusion in the that predominant personality left caudate. In positron states in these participants may emission tomography (PET) and MRI relate to hemispheric balance. studies of DPD participants, While these participants did not Simeon and colleagues (2000) experience the memory loss and found more active sensory dissociation involved with alter- association areas in the left switches in DID, further studies hemisphere, with increased of such neurologically based DID- metabolic rates in the left like symptoms may lead to a parietal and occipital regions. better understanding of the brain An increase in metabolic activity functions involved in relation to particularly in Brodmann’s area the personality states of DID. 7B showed a significant positive SPECT studies reported a correlation with participants’ significant blood flow increase dissociative and in DID patients’ left temporal depersonalization scores. areas versus control areas, as The left frontal and right well as a similar increase in DID and left temporal areas may be patients versus normal involved with the phenomena of participants (Saxe, Vasile, Hill, multiple personalities. In 12 Bloomingdale, & Van der Kolk, participants with left or right 1992; Sar, Unal, Kiziltan & temporolimbic epilepsy, 7 Ozturk, 2001). DID participants manifested clinical signs (n= 2), a control group, and 13 IDENTITY DISORDER BRAIN CORRELATES patients diagnosed with hysteria hypofusion reported by Sar et al. were given a battery of (2001) in their DID participants neuropsychological tests, has also been seen in including the Wechsler Adult schizophrenic participants Intelligence Scale (WAIS-R), and (Andreasen, Swayze, Flaum, EEG readings O’leary and Alliger, as cited in (Flor-Henry, Tomer, Kumpula, Sar et al.). These similarities Koles and Yeudall, 1990). In may help explain the fact that both participants with DID, left some DID patients have initially hemisphere activation was been diagnosed with schizophrenia pronounced in all conditions, as (Flor-Henry et al., 1990). Both opposed to the controls where participants in this study hemisphere activation was task- displayed dominant left temporal dependent (left: language; right: and bilateral frontal dysfunction spatial), and the hysterics, before treatment. One of those where right hemisphere activation participants was tested after was reported. successful treatment of DID. Hughes, Kuhlman, Fichtner and Although still displaying Greunfeld (1990) studied EEG evidence of frontal dysfunction, brain maps of a DID patient and the post-treatment test results found bilateral abnormalities no longer showed evidence of present in their participant’s dysfunction in her left temporal temporal lobes, to a greater area. degree on the left. The Tsai, Condie, Wu, and Chang researchers compared the (1999), used functional magnetic topographic maps of their resonance imaging (fMRI) in a DID participant’s core personality patient. The results showed a versus those maps of a number of significantly smaller volume in her alters. The results showed the participant’s right differences in left or right hippocampus, although her total temporal areas between the intracranial volume was within participant’s core personality normal limits. This is similar and her alters, in varying to the decreased hippocampal degrees depending on the specific volume seen in Alzheimer’s alter personality. No patients, which may relate to the differences were seen in the maps memory gaps in DID patients. of the participant’s core These results are also consistent personality and those of the with reports of hippocampal participant while pretending to reduction in patients with PTSD, be characters similar to her both of which reflect the long- alters, and no differences were term effects of stress on memory, seen in those of an actress especially on hippocampal performing the same roles. The processes, as seen in previous participant’s psychiatrist, blind animal studies (Sapolsky, as to the mapping results and cited in Tsai et al., 1999). familiar with the participant’s Tsai and colleagues’ DID different personalities, was participant scored in the normal asked to rank the alters in four range on the Wechsler memory groups, as they related in scale, indicating that she did similarities to the core not have functional memory personality. impairment. This supports the Some of the beta 2 frequency concept that DID and related PTSD changes Hughes et al. (1990) stemming from childhood abuse do found on the left temporal and not necessarily have the same temporal-parietal-occipital areas effects on the brain as seen in are similar to findings reported combat-related PTSD, where a in schizophrenics. Orbito-frontal decrease in right hippocampal 14 IDENTITY DISORDER BRAIN CORRELATES volume has been reported along (measuring cortisol levels in with correlated deficits in blood versus saliva) and to the short-term verbal memory relatively small sample sizes in (Sapolsky, as cited in Tsai et both studies. Despite these al., 1999). discrepancies, the implications As is often the case with are the same; DPD and possibly DID, all of the participants in other primary dissociative Sar et al. (2001) fit the conditions are linked with diagnostic criteria for several changes in HPA activity and different psychiatric disorders cortisol levels. Furthermore, as well. Tsai et al. (1999) had a when depersonalization was similar confounding aspect in induced by the seratonin agonist their fMRI study of a DID patient meta-chlorophenylpiperazine (m- comorbidly presenting with PTSD, CPP), an increase in pointing out that it is virtually depersonalization scores impossible to find a DID patient correlated with an increase in who does not fit the criteria for anxiety and depressive at least one other disorder. MRI symptomatology (Simeon, research has shown a reduction in Hollander, Stein, DeCaria, Cohen, left hippocampal volume in Saoud, et al. 1995). Stress also participants reporting childhood plays a role in DID, as switching sexual victimization and/or to and from alters often occurs related PTSD (Bremner et al. and in response to a stressful Stein et al., as cited in Sar et situation (Beere, 1996). More al., 2001). PET and cerebral studies on this relation between blood flow (CBF) studies were stress and dissociation are done with other participants who needed to determine if the have reported extensive childhood anxiety and depression found in abuse and victimization, who do Simeon and colleagues’ study was or do not manifest PTSD, and who in response to administration of do not manifest symptoms of DID m-CPP or to the resulting (Rauch et al. and Shin et al., as depersonalization. cited in Sar et al., 2001). These Interesting implications can studies implicate different be found in some studies not regions than the left hemispheric directly on dissociative regions prevalent in the studies disorders, but involving of DID participants. Further activation of related experiences research may help determine the and possibly related brain extent to which left temporal functions. Out-of-body dysfunctions may be related experiences (OBEs) were specifically to the phenomena of repeatedly induced by electrical dissociation and not attributed stimulation of the right angular to the participants’ traumatic gyrus (Blanke, Ortigue, Landis, childhood experiences and and Seeck, 2002). Due to the comorbid sympomatology. proximity of the vestibular The role of stress in cortex, the researchers suggest dissociative disorders can be that dissociative self/body seen in research of the experiences such as OBEs may hypothalamic-pituitary-adrenal relate to an integrative failure axis (HPA) in DPD patients in complex vestibular and (Simeon et al., 2001). These somatosensory processing. This is studies demonstrated different consistent with Simeon and results, one showing an increase colleagues findings in DPD and one showing a decrease in participants that demonstrated an relation to depersonalization, extensive pattern of metabolic but this might be due to the activity in major somatosensory different techniques used and association areas (2000). 15 IDENTITY DISORDER BRAIN CORRELATES Lehmann, Faber, Achermann, alter versus in the primary Jeanmonod, Gianotti, and personality state. In the fMRI Pizzagalli (2001), recorded EEG results found by Tsai et al and low resolution (1999), the switching process electromagnetic tomography from one alter to another (LORETA) from a participant in involved a bilateral reduction in advanced meditation, hippocampal and medial temporal demonstrating some interesting activity, more so on the right results that may be relevant to side, as well as in small regions dissociative disorders. Self- of the substantia nigra (SN) and dissolution meditation involves globus pallidus. When the what the participant described as participant switched from an concentrating ‘‘on the experience alter back to the core of dissolution of the self into a personality state, fMRI showed boundless unity (emptiness)’’ activation only in the right (p.112). Distinctly different hippocampus. Guided imagination from readings of the of irrelevant personality states visualization and mantra-chanting did not evoke significant change. meditations, in which task- These results imply that the related activation was seen processes of dissociation and (right posterior and left personality-state switching in central, respectively), the DID patients has a strong readings during self-dissolution hippocampal involvement, showed activation only in the consistent with the left and right superior and anterior areas right temporal abnormalities and of the frontal gyrus. This region changes that are reported in many has been implicated in various neurological studies of DID studies regarding self-awareness patients (Ahern et al., 1993; and self-recognition (Fink et Flor-Henry et al. 1990; Hughes et al., Craik et al., Vogeley et al., 1990; Sar et al., 2001; Saxe al.; and Keenan et al. as cited et al., 1992; and Tsai et al., in Lehmann et al., 2001), and may 1999). play an important role in the The results in Tsai et al. dysfunctional self experiences of (1999) are from a limited single dissociative disorders. case report and could reflect a Abnormalities in the right compensatory hippocampal response hemisphere are represented in the to some other primary deficit not brain studies of dissociative detected by fMRI. These results disorders. When symptomatology of are also limited by the fact that DPD was induced through this was a patient already in the administration of process of psychotherapeutic tetrahydrocannabinol (THC) CBF treatment for years and that the increased globally (Mathew, switches were consciously Wilson, Chiu, Turkington, induced. The need to consciously Degrado, & Coleman, 1999). induce switching for the sake of However, this increase was test reliability does eliminate greater in the right hemisphere, some interesting possibilities. particularly frontal and the Spontaneous alter shifts often anterior cingulate. A positive occur as a result of stress correlation between (Beere, 1996). FMRI brain imaging depersonalization scores and during such a shift might thus right frontal and anterior show specific involvement of the cingulate CBF increase was found. amygdala, not just the general Measuring CBF in a DID temporal lobe or hippocampal participant, Mathew, Jack, and activity already seen. Tsai and West (1985), found an increase in colleagues also found a bilateral right temporal activation in the reduction in a small part of the 16 IDENTITY DISORDER BRAIN CORRELATES substantia nigra (SN), which is of the limbic system, the implicated in the processes of hippocampus, and possibly the movement and posture. Perhaps a amygdala in these disorders. person with DID experiences a Although these disorders are very quick and subtle shutting rare, due to the nature and down of the body’s positioning intensity of dysfunctions in the while switching occurs, preparing participantive experience of for the new identity state to self, further neurological take control. However, these research on dissociation may results may have nothing to do present information not only with the switching process. applicable in relation to these Further investigation may help disorders, but to the further determine what role, if any, the understanding of the brain and hippocampus, amygdala and SN do the human experience of self. play in alter shifting and dissociation. Author Notes Conclusions For correspondence plase contact The brain areas related to Dr. Julian Keenan at the somatosensory processing are Department of Psychology implicated in DPD, consistent 225 Dickson Hall, Montlcair State with the symptomatology of University, Upper Montclair, NJ feeling detached from oneself. In 07043 DID, a disorder characterized to a great extent by issues of References memory, the hippocampus probably Ahern, G. L., Herring, A. M., plays a strong role, which Tackenberg, neurological research is J., Seeger, J. F., Oommen, K. beginning to demonstrate. Because J., Labiner, of the implications of the D. M., et al. (1993). The hippocampus in the switching association of process, Tsai and colleagues multiple personality and (1999) suggest that bringing temporolimbic forth and integrating a patient’s epilepsy. Archives of memories may be key to Neurology, 50, successfully treating and 1020-1025. integrating the alter personality states in a DID patient. This is American Psychiatric Association. consistent with the notion to (1994). date that the most successful Diagnostic and statistical treatment for DID is long-term manual of mental th psychotherapy and in particular disorders (4 ed.). psychoanalysis, a therapeutic Washington, DC: process in which memory plays an American Psychiatric important role. Association. Some of the dysfunctional brain processes implicated in DID Beere, D. (1996). Switching: Part and DPD studies may be different; I. 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