Measuring fragmentation in dissociative identity disorder: the integration measure and relationship to switching and time in therapy

Some people with dissociative identity disorder (DID) have very little communication or awareness among the parts of their identity, while others experience a great deal of cooperation among alternate identities. Previous research on this topic has been sparse. Currently, there is no empirical measure of integration versus fragmentation in a person with DID. In this study, we report the development of such a measure. The goal of this study was to pilot the integration measure (IM) and to address its psychometric properties and relationships to other measures. The IM is the first standardized measure of integration in DID. Eleven women with DID participated in an experiment that included a variety of tasks. They filled out questionnaires about trauma and dissociation as well as the IM. They also provided verbal results about switching among alternate identities during the study sessions. Participants switched among identities an average of 5.8 times during the first session, and switching was highly correlated with trauma. Integration was related to switching, though this relationship may be non-linear. Integration was not related to time in psychotherapy. The IM provides a useful beginning to quantify and study integration and fragmentation in DID. Directions for future research are also discussed, including expanding the IM from this pilot. The IM may be useful in treatment settings to assess progress or change over time.解离性身份障碍（Dissociative Identity Disorder, DID）患者中，部分群体的各身份片段间几乎不存在沟通与觉知，而另一部分群体则在交替身份间存在大量协作。目前针对该主题的既往研究较为匮乏，且尚无用于评估DID患者身份整合与碎片化程度的实证性测评工具。本研究报道了此类测评工具的开发过程，研究目标为对身份整合测评量表（Integration Measure, IM）进行预试验，并考察其心理测量学特性以及与其他测评工具的关联。IM是首个针对DID患者身份整合程度的标准化测评工具。本研究共招募11名女性DID患者参与包含多项任务的实验，受试者填写了关于创伤与分离症状的问卷以及IM量表，并口头报告了研究过程中交替身份切换的相关情况。受试者在首次实验环节中平均切换身份5.8次，身份切换频率与创伤经历呈显著相关。身份整合程度与身份切换存在关联，但该关联可能呈非线性特征；而身份整合程度与心理治疗时长并无关联。IM为量化与研究DID患者的身份整合与碎片化程度提供了首个实用的开端。本研究同时探讨了未来研究方向，包括基于本次预试验对IM进行扩充完善。IM还可在临床治疗场景中用于评估患者随时间推移的病情进展或变化情况。