Preliminary Evidence of a Missing Self Bias in Face Perception for Individuals with Dissociative Identity Disorder

ABSTRACT

Failing to recognize one’s mirror image can signal an abnormality in one’s sense of self. In dissociative identity disorder (DID), individuals often report that their mirror image can feel unfamiliar or distorted. They also experience some of their own thoughts, emotions, and bodily sensations as if they are nonautobiographical and sometimes as if instead, they belong to someone else. To assess these experiences, we designed a novel backwards masking paradigm in which participants were covertly shown their own face, masked by a stranger’s face. Participants rated feelings of familiarity associated with the strangers’ faces. 21 control participants without trauma-generated dissociation rated masks, which were covertly preceded by their own face, as more familiar compared to masks preceded by a stranger’s face. In contrast, across two samples, 28 individuals with DID and similar clinical presentations (DSM-IV Dissociative Disorder Not Otherwise Specified type 1) did not show increased familiarity ratings to their own masked face. However, their familiarity ratings interacted with self-reported identity state integration. Individuals with higher levels of identity state integration had response patterns similar to control participants. These data provide empirical evidence of aberrant self-referential processing in DID/DDNOS and suggest this is restored with identity state integration.

KEYWORDS:

• Dissociative identity disorder
• cognitive processes
• complex PTSD
• dissociative disorders
• perception
• posttraumatic stress disorder

Authorship

LAML, JDW, SW, KJR and MLK developed the study concept and design. LAML, JDW, CEB, and SBH performed data collection. MLK and SW performed diagnostic interviews. LAML, JDW, and SBH performed the data analysis and interpretation under the supervision of MLK and KJR. LAML drafted the paper, and all authors provided critical revisions. All authors approved the final version of the paper for submission.

Acknowledgments

We would like to thank the participants for making this research possible; Jaime Pollack, Founder of an Infinite Mind and the Infinite Mind staff; Scott Rauch, MD and Dan Dillon, PhD for discussion and feedback; Isabella Kahhale, BS for data collection assistance.

Conflict of Interest

The authors declared no conflicts of interest with respect to the authorship or the publication of this article.

Clinical Trial Registration

NCT02757339 Evaluating the Neurobiological Basis of Traumatic Dissociation in Women With Histories of Abuse and Neglect

Supplementary material

Supplemental data for this article can be accessed here.

Notes

1. Our use of the term integration is not to be confused with the use of the term “cognitive integration” proposed by Menary (2007), in which he describes a theoretical framework by which cognitive tasks are accomplished by integrated, dynamical interactions of neural, bodily, and environmental processes.

Additional information

Funding

The work was supported by National Institute of Mental Health (NIMH) grant R21MH112956 to KJR and MLK, and NIMH fellowship grant F32MH109274 to LAML, the Anonymous Women’s Health Fund to MLK, the O’Keefe Family Foundation to MLK, the Trauma Scholars Fund to MLK, and the Frazier Foundation Grant for Mood and Anxiety Research to KJR.