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This research investigates whether the Memory Malingering Test (TOMM) could identify individuals with psychiatric dissociative identity disorder (DID) from students who are coached with DID malingering.
Amnesia is a distinctive symptom of DID. Analyzes showed that TOMM ratings correctly classified medical and malingering DID subjects and that simulators were not capable of malingering DID. This research is the first to confirm TOMM in persons with complex trauma and dissociation, a brief test that is suitable for medical and forensic environments. This is crucial given the severe symptomatology and high costs associated with untreated DID, which can be mitigated through accurate diagnosis and treatment.
Dissociative Identity Disorder
DID diagnoses, previously referred to as multiple personality disorder (MPD), have increased exponentially over the past 35 years, leading the nature of this condition to be challenged by various psychological experts and practitioners. However, DID is currently recognized by the DSM-IV-TR as a true psychological disorder that most commonly results from sexual abuse in early childhood.
Evidence for Dissociative Identity Disorder dates back to the Paleolithic era, however, it was not until the late 18th century that cases of ‘exchanged personalities’ were recorded. A 20-year-old woman from southern Germany took on a French aristocrat’s character in 1791 and even started to speak fluent French. Apparently, the woman formed two distinct nationalistic identities (French and German) that rejected any memory or knowledge of it when asked about the other.
Method
Participants
Participants from the DID. Thirty-one individuals diagnosed with DID were recruited either from a Mid-Atlantic psychiatric hospital system or from private regional outpatient practices. The medical department is specialized in trauma condition assessment and treatment, including DDs. Participants in the hospital were recruited by announcements made at community meetings and were encouraged to talk to their treatment team (i.e. doctor and therapist) if they were interested in participating.
Measures
SCID-D-R is a 277-item semi-structured questionnaire that is considered the ‘gold standard’ for the treatment of dissociative disorders. The SCID-D-R has good to excellent reliability and good validity for discrimination. The DESis a 28-point self-report measure of good reliability and validity of dissociative symptoms. It was used as a screening tool for the experimental DID participants to dissociate. The simulators provided accurate responses to the DES and removed those with scores above 30 to ensure they did not have a DD.
The TOMM is a visual memory recall method designed to measure cognitive effort in memory tasks. Every trial begins with 50 typical line drawn photos being shown for 3 every. Such 50 pictures were accompanied by 50 panels, each with one of the previously shown pictures and a new picture. Every when they recognise an object they have previously seen, participants earn a score. For the present study, only the first two trials (total of 100 items) were used as they are deemed sufficient to detect malingering. Previous research has shown that the TOMM is highly successful in differentiating real from feigned commitment, correctly classifying 95% of cases. The internal reliability of the present test was 0.98.
Procedure
The findings of this study were collected as part of a larger evaluation system focused on the treatment of clinical and feigned DID. The research was accepted by the clinical review boards of the sponsoring university as well as the sponsoring psychiatric inpatient facility specialized in the care of traumatized individuals. Before beginning participation, all participants read and signed an informed consent detailing research procedures, risks and drawbacks and reiterating the voluntary nature of participation. A series of assessments and interviews were performed by DID members, which took about 35 hours to complete. At the beginning and end of the test, DID members got two $20 gift cards. Members had opportunities to break throughout the evaluation period and were offered the opportunity to discontinue the assessment indefinitely or use additional support resources if required.
DID simulation providers in 90 minutes completed their assessment packages in small groups, gave their informed consent to receive additional credit and the chance of winner of a $50 gift card if they had the most reliable DID picture for their six-month period. In a questionnaire that identified signs of DID and other psychiatric disorders, they were asked to receive a score of 70% or higher to demonstrate DID symptoms. The knowledge test was passed by each simulator. Simulators were then instructed to complete the TOMM and to answer as if they had DID as much as they could. After the majority of the steps were taken, simulators were advised that a $50 donation card would be randomly distributed to ensure DES responses were anonymous.
Analysis
Research was carried out using version 23 of IBM SPSS. Discriminant Function Analysis (DFA) was used as a classification system for the detection of clinical and simulated DID based on TOMM ratings, including Trial 1, Trial 2, and full scores. DFA was used instead of such methods as logistic regression due to the small sample size that would not have had sufficient power to detect statistical effects in models that were parsimonious with only three predictors. All DFA data-analytic assumptions have been fulfilled.
Results
Statistically significant was the omnibus discriminant method, meaning that the overall TOMM score of a participant in Trials 1 and 2 statistically defined their DID status, whether a person had DID or perceived DID. Trial 1 results reported DID classification, The results of the predictors accounted for 59% of the variance. Trial 1 scores established DID status, meaning that DID results in Trial 1 were lower than those simulating DID.With TOMM Trial 1 scores, 81 percent of the participants were properly classified, the strongest utility scores were achieved. TOMM Trial 1 scores were 78 percent adaptive, 87 percent general, 94 percent positive predictive and 63 percent negative. Furthermore, TOMM Trial 2 scores obtained appropriate utility levels and correctly categorized 73% of participants. TOMM Trial 2 scores had a 64% sensitivity, 97% specificity and 98% positive predictive value, but a 53% negative predictive value.
Discussion and Conclusion
DID can be a majorly underestimated or misdiagnosed disorder in clinical settings. Scientists could test for DID more effectively with a clear distinction between actual DID and imagined and malingered dissociative amnesia or DID. Although it is challenging to diagnose clinical DID and malingered DID accurately, there are well-validated tools and literature. This is a great benefit to us, not only to help us understand the complexity that is DID, but also to help to correctly diagnose a patient suffering from this mental disorder.
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