Brain Imaging Shows Trauma-Related Differences in DID


Dissociative Identity Disorder (DID) has a complicated and controversial history. In this study, published in PLoS 1, researchers from London and the Netherlands explore whether DID is a purely “socioculteral (e.g,, iatrogenic)” illness, finding “important differences regarding regional cerebral bloodflow and psychophysiological responses for different types of identity states in patients with DID.”

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Kermit Cole
Kermit Cole, MFT, founding editor of Mad in America, works in Santa Fe, New Mexico as a couples and family therapist. Inspired by Open Dialogue, he works as part of a team and consults with couples and families that have members identified as patients. His work in residential treatment — largely with severely traumatized and/or "psychotic" clients — led to an appreciation of the power and beauty of systemic philosophy and practice, as the alternative to the prevailing focus on individual pathology. A former film-maker, he has undergraduate and master's degrees in psychology from Harvard University, as well as an MFT degree from the Council for Relationships in Philadelphia. He is a doctoral candidate with the Taos Institute and the Free University of Brussels. You can reach him at [email protected].


  1. can anyone reading this help me understand the implications? i don’t know much about cerebral bloodflow testing. if they are proving the existence of the parts, just because the different parts (“identity states”) show up differently, does that mean that they think they are proving that “d.i.d.” is a brain disease now? or does it show that the experience of having different parts is a real experience?

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    • As I read it, and I’ve just skimmed through the study, it’s the latter, i.e. that “real” DID, dissociating unconsciously to the extent that a person takes on a different personality, does exist, and is not something people fake, as it manifests in the brain in a different way than faking dissociation does.

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      • thanks marian, that’s interesting.

        it’d be great if people would stop seeing “d.i.d.” as less real than other forms of madness. it’s alienating. it’s a lot easier to reject something as a disorder and a defining label when one doesn’t have to use up energy fighting to defend and prove one’s experience as real.

        it’s interesting too because people often say that imagining something is the same as experiencing it, but this seems to say that is not accurate.

        thanks for posting this, kermit.

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  2. It seems to me this study is so flawed as to be completely meaningless.

    I do not know if DID is an existing disorder, I am willing to accept it on others authority that it is. However, it is just as obvious to me that at least some experienced being brainwashed in to believing they had it, when they didn’t.

    The brainwashing they were subjected to is very close to the brainwashing used in destructive high control / high demand groups (IE cults).

    Those who were brainwashed to believe that they had DID believed with every part of their being that the diagnosis was correct. This means the only way to mimic the brain scans on those who might not have DID, but are acting it, is to have subjects who are true believers. It would be completely unethical to use brainwashing to make a person believe they had DID for the purpose of research.

    IE, this research does not actually test those who are brainwashed and so there is no valid comparison in the brain scans.

    This research provides zero valid data, what a waste.


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    • people are not being brainwashed into believing that they have “did”. i imagine what you are referring to is that there are some people who developed “did” due to the severe trauma of being tortured by people in control of groups where brainwashing is one form of abuse they experienced.

      it seems that you are saying that “did” is some kind of exception in “mental illness” because you think that we have to weed through these people’s experiences and choose who is and who isn’t real, and can be defined externally because they are only believed to be true by these individual (crazy) (deluded) brainwashed people.

      the thing is, that’s true for all subjective internal experiences/states. if i am diagnosed with “schizophrenia” and i say that i have seen a vision or heard a voice, will you say that i only believe i saw a vision or i only believe i heard a voice? if i am diagnosed with “bipolar” will you say that when i say i feel sad or euphoric will you be concerned that i am tested for the possibility that i only believe i am feeling sad and i only believe i am feeling euphoric? if this is the case, then none of the research is meaningful.

      belief plays a role in shaping experience , a role that we don’t understand, that’s true, but in no different a way in what we call “did” than any other “mental illness”.

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    • I must admit that I was suspicious toward DID, me too. Mostly because I saw too many people on the internet who were what I would call “bragging” about having it, while at the same time these people also made a very big deal out of emphasizing that they were not “crazy”, they did not have “schizophrenia”, they were traumatized, not genetically defective, brain diseased not-quite-human beings. I have to say that, as someone who both herself has experienced extreme states of mind, and got a “psychosis”/”sz” label, and who works with people labelled with “psychosis”/”sz”, this kind of us-and-them thinking that I see a lot of in the DID-internet community puts me massively off.

      Anyway, my doubts about the existence of DID vanished in a split second one day at work where I saw myself confronted with it. And my contact with the person was both long and close enough to leave no doubt in me that she was dissociating to a DID extent.

      Now, DID is not an officially recognized label in Denmark, so the person in question was labelled with “sz”, and, if one regards psych labels in general as valid categories, which I for one don’t do, in the absence of a specific label for extreme dissociation like “DID”, “sz” was the correct label. Hearing voices and having visions is a form of dissociation only one step from the form that adds different personalities to the voices that then can not only control, but take over the “I”. Same phenomenon, different intensity.

      As for brainwashing people into believing they dissociate when they don’t, I believe it is possible, and that it unfortunately does happen. But I also believe that, just like with false memories, it’s absolutely possible to separate the sheep from the goats, even without brain imaging, and that a “good” therapist anyway never tells the client what s/he thinks has happened/is happening to them, but lets the client tell/show him/her.

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      • internet “did” communities put me off, too (to say it mildly). anyone who thinks that “did” is something to brag about…well, they are missing something pretty big about what the experience is like and what caused it and the way that what caused it continues to cause extreme distress. these people infuriate me, acting like it’s all a game, or a way out of taking personal responsibility. i feel like they are appropriating experience, appropriating a coping skill, a way of surviving extreme trauma, and making it into a game or an identity that can be put on and taken off like a dress. (i think maybe there are small online places that is very different than this picture, but they are a quiet sort of hidden community focused on their distress and getting through the day and privacy.) also, if these people had been in “treatment” for “did”, they would know that being diagnosed with “did” means being treated as if you are a disposable not quite human.

        reading that the people in the public “did” communities compare themselves to people with “schizophrenia” and say those things (i didn’t stay around them long enough to hear this, but i believe it) makes me feel sick and angry. it’d make me worse than suspicious. i am having trouble writing this because i am so angry and sad.

        in communities like mia, where i relate to a lot of people are saying, i have felt a sense of “did” being seen as outside the group, of being the them, of being a label to hide. i didn’t understand why. i see it as us and us. i feel like there is no place for me.

        i don’t regard psych labels as valid categories either. and i agree with you that what is labelled “did” and what is labelled “schizophrenia” is very similar experience.

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  3. This is a very enlightening study. According to many studies on hypnosis/dissociation, the hypnotic state is associated with activations in the anterior insula. The AI is a paralimbic structure with connections with the rostroventral sections of the prefrontal cortex, such as the orbitofriontal and cingulate cortices. And involvement in the ACC section of BA 32, makes sense, since the rostroventral portion of the anterior cingulate is involved in attending to oneself as one dissociates and in self absorbed thought. DID is a state of inner absorption in an attempt to detour one’s attention away from reexperiencing horrendous abuse. DID is not simply “make believe…”. The condition during childhood might have developed in response to make believe play, but in adulthood it is a state of mind and personality. It is obviously maintained by brain structures, the AI and BA 32, that were initially involved in its use. Skeptics, I would recommend reading neuroimaging studies of the hypnotic state, which is a dissociative state, the state of mind in DID. I think science is helping to distinguish DID as a childhood adaptive defense mechanism to horrific abuse that can (in the biologically vulnerable and predisposed individual) develop and mature into DID.

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