Dissociative part-dependent biopsychosocial reactions to backward masked angry and neutral faces: An fMRI study of dissociative identity disorder☆

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Abstract

Objective

The Theory of Structural Dissociation of the Personality (TSDP) proposes that dissociative identity disorder (DID) patients are fixed in traumatic memories as “Emotional Parts” (EP), but mentally avoid these as “Apparently Normal Parts” of the personality (ANP). We tested the hypotheses that ANP and EP have different biopsychosocial reactions to subliminally presented angry and neutral faces, and that actors instructed and motivated to simulate ANP and EP react differently.

Methods

Women with DID and matched healthy female actors (CON) were as ANP and EP (DIDanp, DIDep, CONanp, CONep) consecutively exposed to masked neutral and angry faces. Their brain activation was monitored using functional magnetic resonance imaging. The black-and-white dotted masks preceding and following the faces each had a centered colored dot, but in a different color. Participants were instructed to immediately press a button after a perceived color change. State anxiety was assessed after each run using the STAI-S. Final statistical analyses were conducted on 11 DID patients and 15 controls for differences in neural activity, and 13 DID patients and 15 controls for differences in behavior and psychometric measures.

Results

Differences between ANP and EP in DID patients and between DID and CON in the two dissociative parts of the personality were generally larger for neutral than for angry faces. The longest reaction times (RTs) existed for DIDep when exposed to neutral faces. Compared to DIDanp, DIDep was associated with more activation of the parahippocampal gyrus. Following neutral faces and compared to CONep, DIDep had more activation in the brainstem, face-sensitive regions, and motor-related areas. DIDanp showed a decreased activity all over the brain in the neutral and angry face condition. There were neither significant within differences nor significant between group differences in state anxiety. CON was not able to simulate genuine ANP and EP biopsychosocially.

Conclusions

DID patients have dissociative part-dependent biopsychosocial reactions to masked neutral and angry faces. As EP, they are overactivated, and as ANP underactivated. The findings support TSDP. Major clinical implications are discussed.

Highlights

•

Neural/behavioral differences between EP and ANP exist at a preconscious level.
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EP but not ANP showed a positive attentional bias to masked facial stimuli.
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Masked neutral faces elicited dorsal brainstem and occipitotemporal activity in EP.
•

EP’s reaction pattern suggests preconscious fixation particularly on neutral faces.
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Actors were unable to mimic the neural/behavioral reactions of DID patients.

Related collections

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Author and article information

Contributors

Yolanda R. Schlumpf

Ellert R.S. Nijenhuis

Sima Chalavi

Ekaterina V. Weder

Eva Zimmermann

Roger Luechinger

Roberto La Marca

A.A.T. Simone Reinders

Lutz Jäncke

Journal

Journal ID (nlm-ta): Neuroimage (Amst)

Journal ID (iso-abbrev): Neuroimage (Amst)

Title: NeuroImage : Clinical

Publisher: Elsevier

ISSN (Electronic): 2213-1582

Publication date PMC-release: 12 July 2013

Publication date (Electronic): 12 July 2013

Publication date Collection: 2013

Volume: 3

Pages: 54-64

Affiliations

[a ]Division of Neuropsychology, Institute of Psychology, University of Zurich, Switzerland

[b ]Top Referent Trauma Center Mental Health Care Drenthe, Assen, The Netherlands

[c ]Department of Neuroscience, University Medical Center Groningen, and BCN Neuroimaging Center, University of Groningen, Groningen, The Netherlands

[d ]Private Practice, Eschen, Liechtenstein

[e ]Fribourg General Hospital, Fribourg, Switzerland

[f ]Institute for Biomedical Engineering, University and ETH Zurich, Switzerland

[g ]Division Clinical Psychology and Psychotherapy, Institute of Psychology, University of Zurich, Switzerland

[h ]Department of Psychosis Studies, Institute of Psychiatry, King's College London, London, UK

[i ]International Normal Aging and Plasticity Imaging Center, University of Zurich, Switzerland

Author notes

[* ]Corresponding author at: Institute of Psychology, Division Neuropsychology, University of Zurich, Binzmühlestrasse 14/25, CH-8050 Zurich, Switzerland. Tel.: + 41 44 635 7404; fax: + 41 44 635 7409. y.schlumpf@ 123456psychologie.uzh.ch

Article

Publisher ID: S2213-1582(13)00089-2

DOI: 10.1016/j.nicl.2013.07.002

PMC ID: 3791283

PubMed ID: 24179849

SO-VID: 2a86b6a7-9e2c-4f31-ae10-03d8b8778e3b

License:

This is an open-access article distributed under the terms of the Creative Commons Attribution-NonCommercial-No Derivative Works License, which permits non-commercial use, distribution, and reproduction in any medium, provided the original author and source are credited.

History

Date received : 6 March 2013

Date revision received : 28 June 2013

Date accepted : 3 July 2013

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