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Dissociative identity state-dependent working memory in dissociative identity disorder: A controlled functional magnetic resonance imaging study

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Eline M. Vissia, Andrew J. Lawrence, Sima Chalavi, Mechteld E. Giesen, Nel Draijer, Ellert R.S. Nijenhuis, André Aleman, Dick J. Veltman, Antje A.T.S. Reinders

Original languageEnglish
Article numbere82
JournalBJPsych Open
Issue number3
Published11 May 2022

Bibliographical note

Funding Information: This paper represents independent research part funded by the National Institute for Health Research (NIHR) Biomedical Research Centre at South London and Maudsley NHS Foundation Trust and King's College London (grant number: RE13639). The views expressed are those of the author(s) and not necessarily those of the NHS, the NIHR or the Department of Health. The International Society for the Study of Trauma and Dissociation ( ) is acknowledged for support from their Education and Research Fund. A.A.T.S.R. was supported by the Netherlands Organization for Scientific Research ( ), NWO-VENI grant no. 451-07-009. Publisher Copyright: Copyright © The Author(s), 2022. Published by Cambridge University Press on behalf of the Royal College of Psychiatrists.

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Background Memory function is at the core of the psychopathology of dissociative identity disorder (DID), but little is known about its psychobiological correlates. Aims This study aims to investigate whether memory function in DID differs between dissociative identity states Method Behavioural data and neural activation patterns were assessed in 92 sessions during an n-back working memory task. Participants were people with genuine diagnosed DID (n = 14), DID-simulating controls (n = 16) and a paired control group (post-Traumatic stress disorder (n = 16), healthy controls (n = 16)). Both DID groups participated as authentic or simulated neutral and trauma-related identity states. Reaction times and errors of omission were analysed with repeated measures ANOVA. Working memory neural activation (main working memory and linear load) was investigated for effects of identity state, participant group and their interaction. Results Identity state-dependent behavioural performance and neural activation was found. DID simulators made fewer errors of omission than those with genuine DID. Regarding the prefrontal parietal network, main working memory in the left frontal pole and ventrolateral prefrontal cortex (Brodmann area 44) was activated in all three simulated neutral states, and in trauma-related identity states of DID simulators, but not those with genuine DID or post-Traumatic stress disorder; for linear load, trauma-related identity states of those with genuine DID did not engage the parietal regions. Conclusions Behavioural performance and neural activation patterns related to working memory in DID are dependent on the dissociative identities involved. The narrowed consciousness of trauma-related identity states, with a proneness to re-experiencing traumatising events, may relate to poorer working memory functioning.

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