Vissia Eline M, Lawrence Andrew J, Chalavi Sima, Giesen Mechteld E, Draijer Nel, Nijenhuis Ellert R S, Aleman André, Veltman Dick J, Reinders Antje A T S
Cognitive Neuroscience Centre, University Medical Centre Groningen, University of Groningen, The Netherlands; and Centre for Psychotrauma, Heelzorg, The Netherlands.
Department of Psychological Medicine, Institute of Psychiatry, Psychology & Neuroscience, King's College London, UK.
BJPsych Open. 2022 Apr 11;8(3):e82. doi: 10.1192/bjo.2022.22.
Memory function is at the core of the psychopathology of dissociative identity disorder (DID), but little is known about its psychobiological correlates.
This study aims to investigate whether memory function in DID differs between dissociative identity states.
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.
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.
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.
记忆功能是分离性身份障碍（DID）心理病理学的核心，但对其心理生物学相关性知之甚少。
本研究旨在调查DID患者的记忆功能在分离性身份状态之间是否存在差异。
在一项n-back工作记忆任务的92次测试中评估行为数据和神经激活模式。参与者包括确诊为真性DID的患者（n = 14）、模拟DID的对照组（n = 16）以及配对对照组（创伤后应激障碍患者（n = 16）、健康对照组（n = 16））。两个DID组均以真实或模拟的中性及创伤相关身份状态参与研究。采用重复测量方差分析对反应时间和漏报错误进行分析。研究工作记忆神经激活（主要工作记忆和线性负荷）在身份状态、参与者组及其交互作用方面的影响。
发现了依赖于身份状态的行为表现和神经激活。模拟DID者的漏报错误比真性DID患者少。关于前额顶叶网络，在所有三种模拟中性状态以及模拟DID者的创伤相关身份状态下，左额极和腹外侧前额叶皮质（布罗德曼区44）的主要工作记忆被激活，但真性DID患者或创伤后应激障碍患者未出现这种情况；对于线性负荷，真性DID患者的创伤相关身份状态未激活顶叶区域。
DID患者与工作记忆相关的行为表现和神经激活模式取决于所涉及的分离性身份。创伤相关身份状态下意识的狭窄以及易于再次体验创伤性事件，可能与较差的工作记忆功能有关。
