Page 16 - PIECES OF THE PUZZLE Eline Vissia

CHAPTER 1
Trauma and fantasy models of DID
Supporters of the diametrically opposed trauma and fantasy models (Dalenberg et al. 2012) have engaged in a fierce debate regarding the etiology of DID. The fantasy model (Merckelbach, Muris 2001, Merckelbach, Devilly & Rassin 2002, Piper, Merskey 2004b, Pope et al. 2006, Piper, Merskey 2004a), also referred to as the sociocognitive/iatrogenic model (Spanos 1994, Spanos 1996, Lilienfeld et al. 1999) or non-trauma-related model (Reinders et al. 2012), regards DID as a simulation mediated by high suggestibility and/or fantasy proneness, suggestive psychotherapy and/or suggestive sociocultural influences (Giesbrecht et al. 2007, Rassin, Merckelbach & Spaan 2001, Giesbrecht, Merckelbach 2006, Giesbrecht et al. 2008, Lynn et al. 2012, Merckelbach, Rassin & Muris 2000, Merckelbach, Horselenberg & Muris 2001). The sociocognitive view includes the idea that DID can be easily created in motivated suggestible individuals and that few suggestions would suffice to generate the symptoms of DID (Spanos 1996). Although fantasy proneness and suggestibility refer to different concepts, they are highly correlated (Merckelbach, Van de Ven 2001, Braffman, Kirsch 1999, Levin, Spei 2004) and dissociative symptoms correlate with fantasy proneness, heightened suggestibility, and susceptibility to pseudomemories in student samples (Merckelbach, Muris 2001, Rauschenberger, Lynn 1995). Opponents of the trauma model also suggested that mild cognitive impairment (Giesbrecht et al. 2008) or sleep disturbances (Van Heugten-van der Kloet et al. 2014) can be alternative mediating factors.
The trauma model postulates that DID is related to a combination of factors that include chronic emotional neglect and emotional, physical, and/or sexual abuse from early childhood, insufficient integrative capacity, attachment problems, and lack of affect-regulation by caretakers (Gleaves 1996, Spiegel 2006, Spiegel et al. 2011, Putnam 1992, Van der Hart, Nijenhuis & Steele 2006, Dell, O’neil 2009). Within the trauma-related view DID is thought to be a severe form of posttraumatic stress disorder, belonging at the far end of the spectrum of trauma-related psychiatric disorders (Spiegel 1984, Van der Hart, Nijenhuis & Steele 2005, Steele, Van der Hart & Nijenhuis 2009). Holders of the trauma-related view recognize that some features of dissociative personality states can be influenced by sociocultural factors (Van der Hart, Nijenhuis & Steele 2006), that false positive cases of DID have evolved in a treatment setting, and that some psychiatric patients imitate DID (Draijer,
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