Examining the Integration Measure and the Multidimensional Inventory of Dissociation in DID

Abstract

Purpose:
The process of integration in dissociative identity disorder (DID), in part, involves regaining a relative sense of agency and ownership over feelings, memories, thoughts, and experiences. Empirical research links higher integration to better social functioning and reduced memory disturbances, symptoms of depression, and posttraumatic stress disorder (PTSD). However, empirical research on integration using standardized measures is minimal and the question of how integration relates to different types of dissociative experiences remains unknown. Better understanding of integration would elucidate its underlying mechanisms and ultimately shed light on how to facilitate the process in treatment. Therefore, we explored the relationship between levels of integration and different types of dissociative symptoms in a sample of women with DID.

Methods:
Participants were 42 women with DID (ages 18–65, 14% minoritized race/ethnicity). As part of a larger study, participants completed gold-standard Structured Clinical Interview for DSM-IV Dissociative Disorders (SCID-D) and Clinician-Administered PTSD Scale for DSM-5 (CAPS-5) to assess DID and PTSD, respectively. They also completed a battery of self-report surveys including the Integration Measure (IM) and the Multidimensional Inventory of Dissociation (MID). The IM captures awareness of, understanding, acceptance, communication, and cooperation between dissociative self-states (i.e., “parts”). Lower scores indicate more severe fragmentation with minimal or no communication between or awareness of dissociative self-states. In contrast, higher scores indicate greater awareness of and cooperation among self-states. Of note, the IM does not measure all aspects of integration nor full recovery from DID, as even the highest scores still indicate some experience of dissociative self-states.

To explore relationships between integration and different dissociative experiences, we conducted Pearson correlations between the IM and five MID subscales: amnesia (“memory problems” subscale), depersonalization (“depersonalization” subscale), derealization (“derealization” subscale), identity confusion (“self puzzlement” subscale), and identity alteration (“Helper parts” and “I have parts” subscales). Depersonalization and derealization scores were averaged together to create a combined score. Subscales were chosen for their alignment with the SCID-D framework and their relation to awareness, acceptance, and/or cooperation between dissociative self-states.

Findings:
We identified a positive correlation between “Helper parts” and IM scores, r(40) = 0.55, p < .001. “Memory problems,” “depersonalization/derealization,” and “self puzzlement” were all negatively correlated with IM scores, r(40) = −0.33, p = .016; r(40) = −0.36, p = .010; and r(40) = −0.34, p = .014, respectively. “I Have Parts” was not significantly correlated with IM scores. P-values are Hommel-corrected to account for multiple comparisons.

Conclusions:
We found that increased awareness of, understanding, acceptance, communication, and cooperation between dissociative self-states (i.e., higher IM scores) was linked to decreased memory problems, derealization/depersonalization, and identity confusion on a standardized self-report measure of dissociation. Our findings also suggest that as one experiences more cooperation and communication among dissociative self-states, one is more likely to hear a voice in their head that is soothing, helpful, or protective. Longitudinal work is needed to explore the time course of these changes and causal relationships. Our preliminary results, however, align with expert-consensus guidelines that consider integration to be one therapeutic goal of treatment for DID.