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CHAPTER 1
and performance speed (Boysen, VanBergen 2014). Differences between both DID patients and DID simulating healthy control groups have been reported more broadly, covering several measures (Reinders et al. 2012, Schlumpf et al. 2013, Schlumpf et al. 2014, Brand et al. 2006, Welburn et al. 2003, Hopper et al. 2002). Boysen and VanBergen (2014) noted that if systematic differences in brain functioning will be found between patients diagnosed with DID and DID simulators, this might provide supporting evidence for areas of the brain previously identified as related to DID, thereby contributing to the debate regarding factors of influence in this controversial psychiatric disorder.
Posttraumatic stress disorder
The trauma model posits that DID and posttraumatic stress disorder (PTSD) are etiologically and phenomenologically related disorders (Spiegel 1984, Van der Hart, Nijenhuis & Steele 2005, Bremner 1999). The link between dissociative symptoms and PTSD has been studied in various populations whereby dissociation has been shown to be a strong predictive factor for PTSD (Koopman, Classen & Spiegel 1994, Briere, Scott & Weathers 2005, Wabnitz, Gast & Catani 2013, Shalev et al. 1996, Bremner et al. 1992). Regarding the relationship between complex dissociative disorders and PTSD, one core assumption of the TSDP is that trauma-related disorders can be arranged on a continuum ranging from simple forms of PTSD and acute stress disorders to complex PTSD and DID (Van der Hart, Nijenhuis & Steele 2005).
According to DSM-5, the diagnostic criteria for PTSD include a history of exposure to a traumatic event that meets specific qualifications and symptoms from each of four symptom clusters: intrusion, avoidance, negative alterations in cognitions and mood, and alterations in arousal and reactivity (American Psychiatric Association 2013). The dissociative subtype of PTSD is new to DSM-5 (Lanius et al. 2010, Lanius et al. 2012). This subtype responds to trauma cues with a distinct pattern of neurobiological responses (Lanius et al. 2010) and may benefit differently from current treatments (Lanius et al. 2012) than PTSD patients with the more common undermodulated type, that involves a predominance of re-experiencing and hyperarousal symptoms (Lanius et al. 2010). Such important clinical implications highlight the need to further unravel the complex interplay of traumatic stress, dissociation, and related disorders.
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