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Do I have Dissociative Identity Disorder is often asked on forums like Reddit/r/DID.

I hope that I can help shed some light on the question.

PLEASE EXCUSE THE DUST! IT IS STILL IN THE WORKS…UPDATING…(things may not be as accurate and up to date as I want them to be.)

Intro
What is DID?
Symptoms
Diagnosis
Treatment
Prevention
Case Studies
ICD Classifications
What is Psychosis?
What is the cause of DID?*TW*
Borderline Personality Disorder
Comorbidity
R-doc
Dissociation
Glossary

INTRO

“The magic of our minds is often lost in the mundane details of our daily routines, but the remarkable flexibility of our mental lives remains. Our minds may be directed toward the task at hand—they may be “here” as we concentrate on our daily commute or focus on the contents of a meeting or conversation. Our minds may also be “there,” or any place other than the present situation—they may travel to an upcoming vacation, a favorite memory, or even a to-do list as the morning commute turns into a traffic jam or the staff meeting becomes a tedious exercise in endurance. At other times, our minds may go to a third place—neither here nor there, but nowhere.”

Adrian F. Ward and Daniel M. Wegner (Source)

“Research suggests that people’s minds are separated from their current perceptual environments nearly half the time (Killingsworth and Gilbert, 2010); the mind seems to flit from thought to thought and place to place, stopping in the present environment only when automatic processing cannot handle the task at hand (Mason et al., 2007).”

“People with DID have at least two distinct personalities.”

What is a personality? Well let’s say you have a friend named Fred. You’ve known Fred your whole life. You know that Fred loves rock music and fishing and he hates pop music and ballet. Well, what if one day he happened loved ballet and pop and loathed rock and fishing?

“That means completely different people can occupy the very same physical body. When one “takes over” from another, often the difference in personality is discernible to his or her loved ones not only personality-wise, but also physically.”

So with Dissociative Identity Disorder there are such extremes in someone’s personality per say and when they switch from one personality to the next often times there will be amnesia. You can also think of personalities as alternate states of consciousness or alternate ways of being essentially. So if Fred for example, one day says he likes ballet and pop, he wouldn’t remember liking rock or fishing and deny all comments about it.

“There was a case in which one personality was allergic to orange juice and the other was not, both in the same body. When the immune personality was inhabiting the body, there was no reaction at all to orange juice. However, when the allergic personality would consume orange juice, his body would break out into hives. Further, if the allergic personality would take over even during digestion of orange juice, not having consumed it himself, his body would break out into hives. And then if the immune personality took over, the itching and even the hives would subside. All in the same physical body.”

This is where it gets complicated. You can imagine someone’s brain being compartmentalized. Instead of the brain regions being activated similarly all the time, only parts of the regions are activated sometimes.

“DID reflects a failure to integrate various aspects of identity, memory, and consciousness into a single multidimensional self. Usually, a primary identity carries the individual’s given name and is passive, dependent, guilty, and depressed.”

“When in control, each personality state, or alter, may be experienced as if it has a distinct history, self-image and identity. The alters’ characteristics—including name, reported age and gender, vocabulary, general knowledge, and predominant mood—contrast with those of the primary identity.”

“Certain circumstances or stressors can cause a particular alter to emerge.”

“The various identities may deny knowledge of one another, be critical of one another or appear to be in open conflict.”

“Although these manuals are helpful and even necessary for identifying and treating mental illnesses, Lee Anna Clark, William J. and Dorothy K. O’Neill Professor of Psychology at the University of Notre Dame, along with a small team of other experts, wants researchers and clinicians to revisit how these illnesses are approached. In a new paper published in the invitation-only journal Psychological Science in the Public Interest, Clark and her team present the challenges in using these manuals from a scientific perspective and offer some recommendations for re-conceptualizing the mental disorders they describe.”
Brittany Collins Kaufman (Source)

“The phenomenon of mental illness or psychopathology is much more complex, much more multi-determined, much less categorical than any of us ever thought going into it and than the public realizes,” Clark said.
In America, the DSM “is sort of the Bible” for making mental disorder diagnoses…It’s relied on by health care providers, insurance companies, researchers and others. The ICD, developed by the World Health Organization originally to track health statistics, is the primary diagnostic system used outside the U.S.”

Why do people go undiagnosed?

“Getting a diagnosis of a mental disorder has all sorts of social ramifications,” Clark said. “Both negative, with some stigma attached to it, and also positive — certain individuals who get a diagnosis are then eligible for various services. If you can’t get that diagnosis you can’t get those services.”

“Probably the vast majority of people with mental disorders will never see a professional mental health care worker. It’s an issue that’s much more widespread than educating a small cadre of mental health care professionals. It’s really a broad social problem that we need to address.”

History

A Controversial Diagnosis

“In 1988, Dell surveyed clinicians to assess the reactions they had encountered from others as a result of their interest in dissociative identity disorder (DID), previously called multiple personality disorder. Of 62 respondents who had treated patients with DID, more than 80 percent said they had experienced “moderate to extreme” reactions from colleagues, including attempts to refuse their patients’ admissions to hospitals or to force discharge of their patients, even patients that the respondents felt represented a serious suicidal risk. Dell speculated that the emotional reactions to the diagnosis of DID stemmed from anxiety evoked by the disorder’s “bizarre, unsettling clinical presentation,” similar to some clinicians’ emotional reactions to psychiatric emergency patients. Another reason for the heated controversy surrounding the diagnosis of DID is the dispute over the meaning of observed symptoms: Is DID a disorder with a unique and subtle set of core symptoms and behaviors that some clinicians do not see when it is before their eyes? Or is it willful malingering and/or iatrogenically caused symptoms created by the other clinicians who think something is there that is not? A third and very important reason for the controversy is the fear that criminals will “get off” without being punished by a gullible justice system, which attributes behavior to another personality and does not hold the perpetrator responsible.”

Paulette M. Gillig, MD, PhD (Source)

SYMPTOMS

D Hartman, A H Crisp, P Sedgwick, S Borrow(Source)

Trauma, Attachment, and Did

Paulette M. Gillig, MD, PhD (Source)

Hippocampal and Amygdalar Volumes in Dissociative Identity Disorder

These findings suggest that early abuse associated with a stress-related psychiatric disorder may be related to smaller amygdalar volume. In addition, these findings are in contrast to findings from studies of depression that have shown no differences or larger amygdalar volume in depressed patients, compared with healthy subjects (52).

Patients with true dissociative identity disorder without PTSD essentially do not exist.

Dissociation during traumatic events (also referred to as peritraumatic dissociation [18]) can be considered an adaptive defense mechanism to cope with overwhelming threat that cannot be prevented or escaped [3, 11•]. States of subjective detachment (e.g., depersonalization, derealization, and numbing) may help to create an inner distance to the overwhelming experience by dampening unbearable emotions and reducing conscious awareness of the event. The traumatic situation may be perceived as an unreal film-like scene that is not happening to oneself but observed from a wider distance. Somatoform symptoms such as analgesia and out of body experiences (e.g., the sense of floating above one’s body) may reduce awareness of physical injury [16].

While direct translations between animal and human studies are difficult [21], some models have conceptualized peritraumatic dissociation analogous to the freezing response observed in animals (see, e.g., [16]). The proximity of threat may at first elicit an orienting response, preparing the organism for an active defense mechanism (fight or flight reaction [22]), associated with increased sympathetic nervous system activation (e.g., in heart rate, blood pressure, and release of stress hormones). In situations that cannot be controlled or escaped, the threatened organism may more likely engage in a passive defense mode, accompanied by tonic immobility, increased parasympathic activity, and a “shut-down” of the arousal system [14, 16, 21, 23].

Passive reactions (i.e, tonic immobility) in the face of unescapable threat may enhance survival when the chance of escaping or winning a fight is low or impossible, e.g., by reducing the risk of being detected [23, 24]. As pointed out before, however, translations from animal to human research are complicated by conceptual and methodological differences (see, e.g., [21]).

The amygdala is fundamentally involved in salience detection and emotion processing such as the initiation of stress and fear responses [63, 67–69]. States of detachment (e.g., numbing) may thus be associated with reduced reactivity in this area [70].

Altered glucose metabolism in tempo-parietal regions may play a role in “feeling unreal” [83], e.g., altered consciousness, sensory integration, body schema, and memory, as suggested by observations in patients with temporal lobe epilepsy [84] and research on the role of the temporal lobe in memory processing [32].

Furthermore, the hippocampus and parahippocampal regions may be critical to the understanding of altered memory processing during dissociative states [31–33, 61].

Emotion over-modulation (dissociative response type) is thought to primarily activate frontal regions implicated in cognitive control and emotion downregulation (e.g., dorsal/rostral ACC and mPFC), associated with dampened activity in amygdala and insula. The reversed pattern—diminished frontal recruitment (ACC and mPFC) and hyperactivity in amygdala and insula—is assumed to underlie emotion under-modulation (re-experience response type) [10].

Reduced hippocampal volumes in PTSD [98•, 99] may therefore stem from a history of trauma rather than specific to the diagnosis [100].

Patients with comorbid PTSD+DID showed significantly larger volumes of the putamen and pallidum than PTSD patients without DID [103].

In sum, theoretical assumptions and research in depersonalization/DDD, DID, and D-PTSD suggest a link between dissociative symptoms and alterations in brain regions associated with emotion processing and memory (amygdala, hippocampus, parahippocampal gyrus, and middle/superior temporal gyrus), attention and interoceptive awareness (insula), filtering of sensory input (thalamus), self-referential processes (PCC, precuneus, and mPFC), cognitive control, and arousal modulation (IFG, ACC, and lateral prefrontal cortices).

Eric Vermetten, M.D., Ph.D., Christian Schmahl, M.D., Sanneke Lindner, M.Sc., Richard J. Loewenstein, M.D., and J. Douglas Bremner, M.D. (Source)

Borderline Personality Disorder

Transient stress-related dissociation is a hallmark of BPD  It has been defined as one of the nine diagnostic criteria for the disorder in DSM-IV []. In DSM-V [5], “dissociative states under stress” are still listed among other BPD key features such as emotion dysregulation, instable cognition, impulsivity, and interpersonal disturbances.

Emotion dysregulation in BPD (i.e., heightened sensitivity to emotional stimuli, intense emotions, rapid mood swings, and lack of functional emotion regulation strategies) can have detrimental effects on goal-directed behaviors in every-day life  Numerous studies suggest that a dysfunctional network of fronto-limbic brain regions, including a hyperreactivity of the amygdala and insula, and diminished recruitment of frontal regions (e.g., orbitofrontal cortex (OFC), mPFC, and dlPFC) during emotional challenge may underlie emotion dysregulation in BPD.”

“Stress-related dissociation occurs in about 75–80% of BPD patients [ typically lasting between minutes and hours, or days  The strength, frequency, and intensity of dissociative experiences are positively correlated to self-reported arousal/stress levels .

It has been proposed that stress-related dissociation in BPD may be a form of emotion modulation (e.g., increased attempts to inhibit emotions), comparable to observations in D-PTSD, especially in patients with severe childhood trauma  By interfering with mental resources that are crucial to cognitive functioning , stress-related dissociation may hinder recovery .. BPD patients with high trait dissociation showed significant impairments across multiple neuropsychological domains (including memory, attention, and interference inhibition) . Recent neuroimaging studies further suggest a substantial impact of experimentally induced dissociation on affective–cognitive functioning in BPD”

PSYCHOLOGICAL TIME

No understanding of human behavior can be complete without referring to the notion of time. Indeed, humans can sense the flow of time, but the exact nature of the mechanism by which this is done remains unclear. What humans (and maybe animals) experience are temporal experiences, which are subjective feelings that corresponds to physical time. Psychological time is a product of the mind more than a reflection of natural chronometric order (Trautmann, 1995). It refers to temporal dimensions such as duration, pace and the order of perceived and internal events. Psychological time provides our information processing system with important information that enables us to represent the environment in our cognitive system and to act accordingly.

MEMORY

Forgetting from STS is complete within 30 seconds or less
while forgetting from LTS is either very slow or the material is not forgotten at all (Shiffrin& Atkinson, 1969).

Given that we recognize pictures, faces, tunes, and voices after long periods of time, it is clear that we have long-term memory for relatively literal nonverbal information.

This conception of a series or hierarchy of processing stages is often referred to as “depth of processing” where greater “depth” implies a greater degree of semantic or cognitive analysis. After the stimulus has been recognized, it may undergo further processing by enrichment or elaboration. For example, after a word is recognized, it may trigger associations, images or stories on the basis of the subject’s past experience with the word. Such “elaboration coding” (Tulving & Madigan, 1970) is not restricted to verbal material. We would argue that similar levels of processing exist in the perceptual analysis of sounds, sights, smells and so on. Analysis proceeds through a series of sensory stages to levels associated with matching or pattern recognition and finally to semantic associative stages of stimulus enrichment.

Although certain analytic operations must precede others, much recent evidence suggests that we perceive at meaningful, deeper levels before we perceive the results of logically prior analyses (Macnamara, 1972; Savin & 676 CRAIK AND LOCKHART Bever, 1970).

Such stimuli (for example, pictures and sentences) will be processed to a deep level more rapidly than less meaningful stimuli and will be well-retained. Thus, speed of analysis does not necessarily predict retention. Retention is a function of depth, and various factors, such as the amount of attention devoted to a stimulus, its compatibility with the analyzing structures, and the processing time available, will determine the depth to which it is processed.

To summarize, it is suggested that the memory trace is better described in terms
of depth of processing or degree of stimulus elaboration. Deeper analysis leads to a more persistent trace.

Thus, it is possible, that with an appropriate orienting task and an inappropriate
intentional strategy, learning under incidental conditions could be superior to that
under intentional conditions.

FERGUS I. M. CRAIK AND ROBERT S. LOCKHART (Source)

Dissociation and the Fragmentary Nature of
Traumatic memories:

Overview and Exploratory Study.
Bessel A. van der Kolk
& Rita Fisler

Abstract

Since trauma is an inescapably stressful event that overwhelms people’s coping mechanisms it is uncertain to what degree the results of laboratory studies of ordinary events have relevance to the understanding of traumatic memories.

However, accuracy of memory is affected by the the emotional valence of an experience: studies of people’s subjective reports of personally highly significant events generally find that their memories are unusually accurate, and that they tend to remain stable over time (Bohannon, 1990; Christianson, 1992; Pillemer, 1984; Yuille & Cutshall, 1986). It appears that evolution favors the consolidation of personally relevant information. For example, Yuille and Cutshall (1989)
interviewed 13 out of 22 witnes ses to a murder 4-5 months after the event. All witnesses had provided information to the police within two days after the murder. These witnesses were found to have very accurate recall, with little apparent decline over time. The authors concluded that emotional memories of such shocking events are “detailed, accurate and persistent” (p.181). They suggested that witnessing real “traumas” leads to “quantitatively different memories than innocuous
laboratory events”.

Researchers also have studied the accuracy of memories for culturally significant events, such as the murder of President Kennedy and the space shuttle Challenger. Brown and Kulik (1977) first called memories for such events “flashbulb memories“. While people report that these experiences are etched accurately in their minds, research has shown that even those memories are subject to some distortion and disintegration over time. For example, Neisser and Harsch (1990) found that people changed their recollections of the space shuttle Challenger disaster considerably after a number of years. However, these investigators did not measure the personal significance that their subjects attached to this event. Clinical observations of people who suffer from PTSD suggest that there are salient differences between flashbulb memories and the posttraumatic perceptions characteristic of PTSD.As of early 1995, we could find no scientific literature that had demonstrated that intrusive recollections of traumatic events in patients suffering from PTSD become distorted over time.

Some aspects of traumatic events appear to get fixed in the mind, unaltered by the passage of time or by the intervention of subsequent experience. For example, in our own studies on post traumatic nightmares, subjects claimed that they saw the
same traumatic scenes over and over againwithout modification over a fifteen year period (van der Kol k, Blitz, Burr & Hartmann, 1984).For the past century, many students of trauma have noted that the imprints of traumatic experiences seem to be qualitatively different from memories of ordinary events.

Starting with Janet, accounts of the memories of traumatized patients consistently mention that emotional and perceptual elements tend to be more prominent than
declarative components (e.g. Grinker & Spiegel, 1946; Kardiner, 1941; Terr, 1993). These recurrent observations about the nature of traumatic memories have given rise to the notion that traumatic memories may be encoded differently than memories for ordinary events, perhaps via alterations in attentional focusing, perhaps because of extreme emotional arousal interferes with hippocampal memory functions (Christianson, 1992; Heuer & Rausberg, 1992; Janet, 1889; LeDoux, 1992; McGaugh, 1992; Nillson & Archer, 1992; Pitman, Orr, & Shalev, 1993; van der Kolk, 1994).

Amnesia for these traumatic events may last for hours, weeks, or years. Generally, recall is triggered by exposure to sensory or affective stimuli that match sensory or affective elements associated with the trauma.It is generally accepted that the memory system is made up of networks of related information: activation of one aspect facilitates the recall of associated memories (Collins & Loftus, 1975; Leichtman, Ceci, & Ornstein, 1992).Affect seems to be a critical cue for the retrieval of information along these associative pathways. This means that the affective valence of any particular experience plays a major role in determining what cognitive schemes will be activated. In this regard, it is relevant that many people with trauma histories, such as rape, spouse battering and child abuse, seem to function quite well, as long as feelings related to traumatic memories are not stirred up.However, under particular conditions, they may feel, or act as if they were traumatized all over again. Fear is not the only trigger for such recall: any affect
related to a particular traumatic experience may serve as a cue for the retrieval of trauma-related sensations, including longing, intimacy and sexual arousal.

More research is needed to explore the consistent clinical observation that adults who were chronically traumatized as children suffer from generalized impairment of memories for both cultural a nd autobiographical events. It is likely that the combination of autobiographical memory gaps and continued reliance on dissociation makes it very hard for these patients to reconstruct a precise account of both their past and current reality(Cole & Putn am, 1992).

The combination of lack of autobiographical memory, continued dissociation and of meaning schemes that include victimization, helplessness and betrayal, is likely to make these individuals vulnerable to suggestion and to the construction of explanations for their trauma-related affects that may bear little relationship to the actual realities of their lives.

Recent research has shown that having dissociative experiences at the moment of the trauma (peritraumatic dissociation) is the most important long term predictor for the ultimate development of PTSD (Holen, 1993; Marmar, et al., 1994; Spiegel, 1991).

As people are being traumatized, this narrowing of consciousness sometimes evolves into amnesia for parts of the event, or for the entire experience. Students of traumatized individuals have repeatedly noted that during conditions of high arousal “explicit memory” may fail. The individual is left in a state of “speech less terror” in which the person lacks words to describe what has happened (van der Kolk, 1987). However, while traumatized individuals may be unable to give a coherent narrative of the incident, there may be no interference with implicit memory: they may “know” the emotional valence of a stimulus and be aware of associated perceptions, without being able to articulate the reasons for feeling or behaving in a particular way

More than eighty years ago, Janet observed: “Forgetting the event which precipitated the emotion… has frequently been found to accompany intense emotional experiences in the form of continuous and retrograde amnesia” (Janet, 1909b, p. 1607). He claimed that when people experience intense emotions, memories cannot be transformed into a neutral narrative: a person is “unable to make the recital which we call narrative memory, and yet he remains confronted by
(the) difficult situation” (Janet 1919/1925 , p. 660).

This results in “a phobia of memory” (p. 661) that prevents the integration (“synthesis”) of traumatic events and splits off the traumatic memories from ordinary consciousness.

Janet claimed that the memory traces of the trauma linger as what he called “unconscious fixed ideas” that cannot be “liquidated”as long as they have not been translated into a personal narrative.

Failure to organize the memory into a narrative leads to the intrusion of elements of the trauma into consciousness: as terrifying perceptions, obsessional preoccupations and as somatic re-experiences such as anxiety reactions (Janet, 1909b, van der Kolk & van der Hart, 1991).

Kardiner, in describing the “Traumatic Neuroses of War (1941) noted that when patients develop amnesia for the trauma, it tends to generalize to a large variety of
symptomatic expressions: “(t)he subject acts as if the original traumatic situation were still in existence and engages in protective devices which failed on the original occasion”(p. 82).

Kardiner noted that fixation occurs in dissociative fugue states: triggered by a sensory stimulus, a patient might lash out, employing language suggestive of his trying to defend himself during a military assault.

He noted that many patients, while riding a subway train that entered a tunnel, had flashbacks to being back in the trenches. Kardiner also viewed panic attacks and hysterical paralyses as the re-experiencing of fragments of the trauma.

Piaget (1962) claimed that dissociation occurs when an active failure of semantic(common knowledge)memory leads to the organization of
memory on somatosensory(relating to or denoting a sensation [such as pressure, pain, or warmth] that can occur anywhere in the body, in contrast to one localized at a sense organ [such as sight, balance, or taste].) or iconic levels.

He pointed out: “It is precisely because there is no immediate accommodation that there is complete dissociation of the inner activity from the external
world.

As the external world is solely represented by images, it is assimilated without resistance (i.e. unattached to other memories) to the unconscious ego”.

The realization of the role of dissociation in the processing of traumatic memories was revived for contemporary psychiatry when Horowitz described an acute catastrophic stress reaction in civilian trauma victims, characterized by panic, cognitive disorganization, disorientation and dissociation (1976)

Such dissociative processing of traumatic experience complicates the capacity to communicate about the trauma.

In some people the memories of trauma may have no verbal (explicit) component at all: the memory may be entirely organized on an implicit or perceptual level, without an accompanying narrative about what happened.

Recent symptom provocation neuroimaging studies of people with PTSD support that clinical observation: during the provocation of traumatic memories there was decreased activation of Broca’s area, the part of the CNS most centrally involved in the transformation of subjective experience into speech. Simultaneously, the areas in the right hemisphere that are thought to process intense emotions and visual images had significantly increased activation (Rauch et al., 1995).Ongoing dissociation in traumatized people.

People who have learned to cope with trauma by dissociating are vulnerable to continue to do so in response to minor stresses.The continued use of dissociation as a way of coping with stress interferes with the capacity to fully attend to life’s ongoing challenges.

The severity of ongoing dissociative processes (often measured with the Dissociative Experiences Scale (DES)– Bernstein & Putnam, 1986) has been correlated with a large variety of psychopathological conditions that are thought to be associated with histories of trauma and neglect: severity of sexual abuse in adolescents (Sanders & Giolas, 1991), somatization (Saxe et al.,1994), bulimia (Demitrack et al,1990), self-mutilation (van der Kolk, Perry, & Herman, 1991) and borderline personality disorder (Herman, Perry, & van der Kolk, 1989)

The most extreme example of this ongoing dissociation occurs in people who suffer from dissociative identity disorder(multiple personality disorder),who have the highest DES scores of all populations studied and in whom separate identities seem to contain the memories related to different traumatic incidents (Putnam, 1989).

Clinical experience and reading a century of observations by clincians dealing with a variety of traumatized populations led us to postulate that “memories” of the trauma tend to, at least initially, be predominantly experienced as fragments of the sensory components of the event: as visual images, olfactory, auditory, or kinesthetic sensations, or intense waves of feelings(which patients usually claim to be representations of elements of the original traumatic event).

Traumatic Memory

• Images, sensations, affective and
  behavioral states
• Invariable — does not change over time
• Highly state-dependent. Cannot be
  evoked at will.
• No condensation in time

Narrative Memory

• Narrative: semantic and symbolic
• Social and adaptive
• Automatically evoked in special
  circumstances
• Evoked at will by narrator
• Can be condensed or expanded depending on
  social demands

Table 2 presents the sensory modalities which the subjects reported first having
experienced when they first became aware of the trauma (whether they had always been aware of the trauma, or recovered the memory after a period of amnesia) . No subject reported having a narrative for the traumatic event as their initial mode of awareness (they claimed not having been able to tell a story about what had happened), regardless of whether they had continuous awareness of what had happened , or whether there had been a period of amnesia. There were no statistically significant differences between the subjects with childhood (CT) vs adult trauma (AT) in terms of the sensory modalities first experienced, although there was a trend towards more visual intrusions in the adult trauma group.

Figure 1 indicate that all subjects, regardless of age at which the first trauma occurred, reported that they initially “remembered” the trauma in the form of somatosensory or emotional flashback experiences. At the peak of their intrusive recollections all sensory modalities were enhanced, and a narrative memory started to emerge. Currently, most subjects continued to experience their trauma in sensorimotor modes, but while 41 (89)% were able to narrate a satisfactory story about what happened to them, 5 subjects (11%-all CT) continued to be unable to tell a coherent narrative, with a beginning, middle and end, even though all of them had outside confirmation of the reality of their trauma, i.e. a mother who knew, a prepetrat or who confessed, hospital or court records.

Of the 35 subjects with childhood trauma, 15 (43%) had suffered significant, or
total amnesia for their trauma at some time of their lives.

Twenty seven of the 35 subjects with childhood trauma (77%) reported confirmation of their childhood trauma- from a mother, sibling, or other source who knew about the abuse, from court or hospital records, or from confessions or convictions of the perpetrator(s).

We did not ask them to produce records to prove that this confirmation actually existed.

Discussion
Our study suggests that there are critical differences between the ways people experience traumatic memories versus other significant personal events.

The study supports the idea that it is in the very nature of traumatic memory to be dissociated,and to be initially stored as sensory fragments without a coherent semantic component.

All of the subjects in our study claimed that they only came to develop a narrative of their trauma over time.Five of the subjects who claimed to have been abused as child ren were even as adults unable to tell a complete narrative of what had happened to them.They merely had fragmentary memories that supported other people’s stories, and their own intuitive feelings, that they had been abused.

All these subjects, regardless of the age at which the trauma occurred, claimed that they initially “remembered” the trauma in the form of somatosensory flashback experiences. These flashbacks occurred in a variety of modalities: visual, olfactory, affective, auditory and kinesthetic, but initially these sensory modalities did not occur together.As the trauma came into consciousness with greater intensity, more sensory modalities came into awareness: initially the traumatic experiences
were not condensed into a narrative. It appears that, as people become aware of more and more elements of the traumatic experience, they construct a narrative that “explains” what happened to them.

This transcription of the intrusive sensory elements of the trauma into a personal narrative does not necesarily have a one-to-one correspondence with what actually happened. This process of weaving a narrative out of the disparate sensory elements of an experience is probably not dissimilar from how people construct a narrative under ordinary conditions. However, when people have day-to-day, non-traumatic experiences, the sensory elements of the experience are non registered separately in consciousness, but are automatically integrated into the personal narrative.

This study supports Piaget’snotion that when memories cannot be integrated on a semantic/linguistic level, they tend to be organized more primitively: as visual images or somatic sensations.

Even after considerable periods of time, and even after acquiring a personal narrative for the traumatic experience, most subjects reported that these experiences continued to be come back as sensory perceptions and as affective states.

The persistence of intrusive sensations related to the trauma after the construction of a narrative contradicts the notion that learning to put the traumatic experience into words will reliably help abolish the occurrence of flashbacks.

The CT(Childhood Onset Trauma) group had significantly more pathological self-soothing behaviors than the adult group, including self-mutilation and bingeing

This supports the notion that childhood trauma gives rise to more pervasive biological disregulation, and that patients with childhood trauma have greater difficulty regulating internal states than patients first traumatized as adults (van der Kolk & Fisler, 1994). Another interesting difference between the adult and the child group was that the AT(Adult onset Trauma) group had nightmares that they reported to be exact replicas of the traumatic experience more
often than did the CT group.

It was striking that some subjects, particularly those who never were able to construct a satisfactory narrative of their trauma, did not have visual flashbacks. Intuitively, it would appear to be difficult to construct a satisfactory narration that allows for the proper placement of the trauma in time and space if an individual cannot visualize what has happened. We are currently studying the mental organization of traumatic experiences in blind children and adults.

Our research shows that traumatic experiences initially are imprinted as sensations or feeling states that are not immediately transcribed into personal narratives, in contrast with the way people seem to process ordinary information. This failure of information processing on a symbolic level, in which it is categorized and integrated with other experiences, is at the very core of the pathology of PTSD (van der Kolk & Ducey, 1989).

Recently we collaborated in a neuroimaging symptom provocation study of some of the subjects who were part of the memory study reported here. When these subjects had their flashbacks in the laboratory, there was a significantly increased activity in the areas in the right hemisphere that are associated with the processing of emotional experiences, as well as in the right visual association cortex. At the same time, there was significantly decreased activity in Broca’s area, in the left hemisphere (Rauch et al. 1995). These findings are in line with the results of this study: that traumatic “memories” consist of emotional and sensory states, with little verbal representation.

In other work we have hypothesized that, under conditions of extreme stress, the hippocampally based memory categorization system fails, leaving memories to be stored as affective and perceptual states (van der Kolk, 1994). This hypothesis proposes that excessive arousal at the moment of the trauma interferes with the effective memory processing of the experience. The resulting “speechless terror” leaves memory traces that may remain unmodified by the passage of time, and by further experience.

While trauma may leaveindelible(not able to be forgotten or removed.) sensory(relating to sensation or the physical senses; transmitted or perceived by the senses.) and affective(relating to moods, feelings, and attitudes.) imprints,
once these are incorporated into a personal narrative this semantic(common knowledge) memory, like all explicit memory(Explicit memory [or declarative memory] is one of the two main types of long-term human memory. …Explicit memory involves conscious recollection, compared with implicit memory which is an unconscious, unintentional form of memory.), is subject to varying degrees of distortion.

Implicit memory is sometimes referred to as unconscious memory or automatic memory. Implicit memory uses past experiences to remember things without thinking about them. The performance of implicit memory is enabled by previous experiences, no matter how long ago those experiences occurred.Feb 12, 2014

Making the Diagnosis: Clinical Description

“The typical patient who is diagnosed with DID is a woman, about age 30. A retrospective review of that patient’s history typically will reveal onset of dissociative symptoms at ages 5 to 10, with emergence of alters at about the age of 6. Typically by the time they are adults, DID patients report up to 16 alters (adolescents report about 24), but most of these will fade quickly once treatment is begun.

There generally is a reported history of childhood abuse, with the frequency of sexual abuse being higher than the frequency of physical abuse. Patients who have been diagnosed with DID frequently report chronic suicidal feelings with some attempts. Sexual promiscuity is frequent but patients usually report decreased libido and an inability to have an orgasm. Some patients report that they dress in clothing of the opposite gender or that they, themselves, are of the opposite gender. Patients often report “extrasensory experiences” related to dissociative symptoms, sometimes called hallucinations. They report hearing voices, periods of amnesia, periods of depersonalization, and may use the plural (“we” instead of “I”) when referring to the self.

These patients experience so much dissociation and also many somatic symptoms (some cases resemble Briquet syndrome or somatization disorder[when a person feels extreme anxiety about physical symptoms such as pain or fatigue. The person has intense thoughts, feelings, and behaviors related to the symptoms that interfere with daily life. A person with SSD is not faking his or her symptoms.])40 that they have a very inconsistent work history.41

Patients usually have periods of time for which they cannot account, may meet people who know them but whom they do not recognize, and find clothes in their possession that they do not recall purchasing and normally would not wear.”

TREATMENT

Approaches to Treatment

“Patients who have been diagnosed with DID tend to possess extreme sensitivity to interpersonal trust and rejection issues, and this makes brief treatment in a managed care setting difficult.14 Therapists who commonly treat patients with DID see them as outpatients weekly or biweekly for years, with the goal of fusion of the personality states while retaining the entire range of experiences contained in all of the alters.”

“Patients tend to switch personality states when there is a perceived psychosocial threat. This switching allows a distressed alter to retreat while an alter who is more competent to handle the situation emerges. The alter system may replicate the DID patient’s experience of the relationships and circumstances that prevailed in the family of origin.3 In Kluft’s view,3 alternate identities or personality states are the core phenomena of DID.

Kluft does not view the alters as obstacles, distractions, or artifacts to be bypassed or suppressed. In fact, he argues that he has found no evidence of improvement if the therapist does not work with these alternate personality states.”

“According to Kluft, large systems of alters usually collapse as the treatment moves forward and so it is not necessary to be overly concerned if the patient experiences a large number of personality states. It is important to get to know the prominent personality states, however, because sometimes one assumes that the host personality constitutes the patient’s true identity, but this may not be the case.3”

“One of the most important issues to deal with in treatment is the fear on the part of an acting-out or antisocial personality state that he or she will be obliterated by therapy—that the psychiatrist’s goal is to “get rid” of an “alter” who may have committed illegal, even violent, acts. This would not be an appropriate goal of treatment.”

Not all multiples are violent or criminals. If people heal their trauma they will not end up repeating the patterns that were done to them.

The personality state was created to defend the self against abuse and injury and can become a strong and important element when integrated more adaptively into the overall personality structure.23“

EMDR

“Severe child abuse, a disorganized and disoriented attachment style,^25,26 and the absence of social and familial support seem to precede the development of DID.

Aetiology

Dissociative disorders are said to develop as a result of two psychological defence mechanisms, dissociation and conversion, that are used to cope with trauma or emotional conflict that is so painful or distressing it cannot be allowed into the conscious mind. Dissociation results in a loss of integration between mental functions. In conversion, distressing thoughts are transformed (‘converted’) into physical symptoms, sometimes in a way that symbolises the trauma or conflict that caused them. For example, a boy who witnessed the murder of his mother developed dissociative sensory loss that presented with blindness.

CASE STUDIES

CASE 1

The patient is a 48-year-old woman with a history of seizures since the age of 39. She described a 1997 British Epilepsy Association typical episode as preceded by a headache lasting several hours, followed by palpitations and a
sensation of anxiety. She then would lose awareness, stare and typically would ‘clean up the apartment’. She stated that the episodes were brief, lasting l-2 minutes, but at times last as long as 30 minutes. She reported feeling confused and agitated afterwards. Magnetic resonance imaging (MRI) of the brain and an electroencephalogram (EEG) were normal. She continued to have approximately four episodes per month on sequential trials of phenytoin, carbamazepine and gabapentin.

She had a history of depression and was being treated with amitriptyline 25 mg per day. She also had multiple psychiatric admissions for depression and agitation, at times associated with paranoia. She continued to carry a diagnosis of epilepsy during these multiple hospitalizations, and it was thought that some of her hospitalizations were due to postictal paranoid psychosis.

Her recent admission to the psychiatric unit was prompted by an exacerbation of depression, agitated behaviour and paranoia. She was started on perphenazine and benztropine which improved her thought processes and paranoia. She had several possible seizures witnessed by the psychiatry staff, and was transferred to the neurology unit to undergo video-EEG monitoring.
The patient reported several typical events during 2 weeks of recording, during which no epileptiform or otherwise abnormal EEG changes occurred, and no specific behavioral alterations were noted by the staff. In addition, an episode lasting 12 minutes (described by the patient as similar to her usual episodes) was produced by intravenous saline injection, again with no epileptiform change on the EEG.

No interictal EEG abnormalities were found, and the EEG was interpreted as normal. The patient was diagnosed as having pseudoseizures and was transferred back to the psychiatry unit having had her antiepileptic medicines discontinued. Upon returning to the psychiatric unit, ia, delusions or hallucinations. Her thinking was mildly tangential. Further history corroborated by her sister revealed that she had suffered extensive, sustained, at times bizarre, childhood sexual and physical abuse at the hands of her mother and step-father. Her diagnoses on discharge were dissociative disorder with psychogenic fugue states and amnesias, post-traumatic stress disorder, and borderline personality disorder. Her prescribed treatment was to continue
her current medicines prescribed by her psychiatrist and to continue group and individual psychotherapy.

CASE 2
The patient is a 38-year-old woman with a history of abnormal ‘spells’ for the past 7 months. Her episodes lasted 5-10 minutes and consisted of her being suddenly unable to speak or to move, associated with a decrease in awareness. At times, she reported hand trembling during the spells, but had no other associated movements. She denied an aura or prodrome to the episodes, and did not have incontinence during the episodes. She stated that her spells were brought on by stress or anger, and that she felt extremely anxious around the
time of the spells. They occured 2-3 times per week. Her previous medical history is remarkable only for uterine fibroids. She has a history of alcohol abuse and intranasal cocaine use, stopped 12 years prior to the onset of her current problem. On psychiatric examination she had a pervasive sad and anxious mood, and reported insomnia and decreased enjoyment of daily activities. She was slightly suspicious, but did not have evidence of thought disorder. She did have passive suicidal ideation. It was further revealed that she was physically and sexually abused as a child. She was recently evaluated by an outside psychiatrist in her neighborhood and it was recommended that
she start respiridone 1 mg per day, which she would not take before having further neurological evaluation. Her neurological exam was normal.
An EEG was performed during which an alcohol pad test4 was performed on the patient. An alcohol swab gently applied to one side of her neck quickly precipitated a typical event as described lasting 10 minutes, without an epileptiform EEG change. The EEG was otherwise
normal.

The patient was diagnosed by the psychiatric staff as having a dissociative disorder with amnestic episodes and possible depression. She was relieved when she was told that her episodes were not epileptic and were a result of emotional conflict best treated with psychotherapy.

Hypothesis that dissociative disorders are caused by an epileptic mechanism. In evaluating this relationship, the dissociative experiences scale (DES) has been used, which is a selfadministered, 28-item questionnaire that can reliably differentiate patients with the dissociative disorders of multipole personality and posttraumatic stress from normal subjects and from patients with other psychiatric illnesses.

Although arriving at exact psychiatric diagnosis or set of diagnoses appears to be problematic in pseudoseizure patients, the idea of ‘seizures’ resulting from an inappropriate sexual experience has been put forth since antiquity and remains validated by modern reports.

The second-century C.E. Greek physician, Galen, taught that seizures
were a result of premature intercourse in childhood.

The documented historical relationship between abuse and dissociation and
between abuse and pseudoseizures is compelling evidence that a similar mechanism is involved.

A history of trauma and abuse may not be forthcoming on an initial interview, and if reported, it is advisable to obtain independent corroboration that the events actually occurred.

The development of dissociative disorders in adulthood appears to be related to the intensity of dissociation during the actual traumatic event(s); severe dissociation during the traumatic experience increases the likelihood of generalization of such mechanisms following the event(s). The experience of ongoing trauma in childhood significantly increases the likelihood of developing dissociative disorders in adulthood (International Society for the Study of Dissociation, 2002; Kisiel & Lyons, 2001; Martinez-Taboas & Guillermo, 2000; Nash, Hulsey, Sexton, Harralson & Lambert, 1993; Siegel, 2003; Simeon et al., 2001; Simeon, Guralnik, & Schmeidler, 2001; Spiegel & Cardeña, 1991).

Liotti’s model is supported by the findings of a study by Ogawa, et al., which measured the dissociative symptomology of 168 18- to 19-year-old subjects four times across 19 years and found that disorganized attachment during infancy was a strong predictor of later dissociative symptoms . The fact that the extraordinary symptoms of DID can be traced to clear neurobiological and neurodevelopmental origins is an undeniable example of the amazing potential of the brain’s neuroplasticity.  However, while some cases of DID might have iatrogenic origins, the attachment-OFC model provides an undeniable neurobiological basis for traumagenic origins of DID, thus refuting the possibility of a purely iatrogenic model of DID.

Recent Neurosciences Research on Dissociative Identity Disorder: Attention and Memory

DID patients showed increased vigilance(the action or state of keeping careful watch for possible danger or difficulties), resulting in reduced habituation of startle reflexes and increased PPI(prepulse inhibition). This response is a voluntary process that directs attention away from unpleasant or threatening stimuli.

The authors concluded that aberrant( A defect of focus, such as blurring in an image.) voluntary attentional processes may thus be a defining characteristic of DID.31

Loewenstein16 and Bliss17 concluded that DID existed and spontaneous autohypnotic symptoms were basic to the phenomenology of DID.

Gelinas18 described autohypnotic and posttraumatic stress disorder (PTSD) symptoms in DID patients that likely were a response to childhood sexual abuse.

Spiegel and Rosenfeld19 attributed the “spontaneous age regression” (to a younger alter) seen in DID patients to early trauma and also believed that PTSD symptoms related to trauma were central to DID.

The tendency to dissociate seems to be related as much to a pathogenic(causing disease) family structure and attachment disorder acquired early in the life of the child as to original temperament or genetics.

Parenting style toward these patients was usually authoritarian and rigid, but paradoxically with an inversion of the parent-child relationship.27

Blizard28 speculated that children who display a disorganized/disoriented pattern of attachment29 might be in the process of dissociating their representations of contradictory parent behavior and that, in DID, distinct patterns of attachment may have been incorporated into the various personalities.

IS D.I.D. GOOD OR BAD?

“Further research is needed to clarify whether or not the symptoms of DID actually perform a protective, defensive function neurologically by creating a neuroprotective environment that ameliorates the neurotoxic effects of traumatic stress. This would be predicted by the adaptive hypothesis described by Stankiewicz and Golczynska.39“

These interventions include patient and family education, therapies, family interventions, assertive community treatment, social skills training, and supported employment.

Do children react differently than adults?

Children and teens can have extreme reactions to trauma, but their symptoms may not be the same as adults. In very young children (less than 6 years of age), these symptoms can include:

• Wetting the bed after having learned to use the toilet
• Forgetting how to or being unable to talk
• Acting out the scary event during playtime
• Being unusually clingy with a parent or other adult

The legal system’s effectiveness can be improved by deepening our understandings about why people behave as they do and both how and why people respond to various changes in legal incentives.

According to the ICD-10:

F43 Reaction to severe stress, and adjustment disorders

This category differs from others in that it includes disorders identifiable on the basis of not only symptoms and course but also the existence of one or other of two causative influences: an exceptionally stressful life event producing an acute stress reaction, or a significant life change leading to continued unpleasant circumstances that result in an adjustment disorder. The disorders in this section can thus be regarded as maladaptive responses to severe or continued stress, in that they interfere with successful coping mechanisms and therefore lead to problems of social functioning.

F44.0Dissociative amnesia

The main feature is loss of memory, usually of important recent events, that is not due to organic mental disorder, and is too great to be explained by ordinary forgetfulness or fatigue.

The amnesia is usually centred on traumatic events, such as accidents or unexpected bereavements, and is usually partial and selective.

Complete and generalized amnesia is rare, and is usually part of a fugue (F44.1). If this is the case, the disorder should be classified as such. The diagnosis should not be made in the presence of organic brain disorders, intoxication, or excessive fatigue.

F44.1Dissociative fugue

Dissociative fugue has all the features of dissociative amnesia, plus purposeful travel beyond the usual everyday range. Although there is amnesia for the period of the fugue, the patient’s behaviour during this time may appear completely normal to independent observers.

F44.5Dissociative convulsions

Dissociative convulsions may mimic epileptic seizures very closely in terms of movements, but tongue-biting, bruising due to falling, and incontinence of urine are rare, and consciousness is maintained or replaced by a state of stupor or trance.

 Pseudoseizure patients frequently report a history of physical and sexual abuse, and traumatic experience is considered part of the mechanism for producing dissociation. Pseudoseizures may be a manifestation of dissociative disorder, especially when a history of sexual or physical abuse is documented. A common mechanism involving traumatic experience may be present in both pseudoseizures and dissociative disorders. A complete neurodiagnostic evaluation along with an awareness of this relationship is needed to provide appropriate care for this patient population.

Paroxysmal alterations of awareness are at particular risk for being interpreted as having epilepsy by health professionals. 

F62.0Enduring personality change after catastrophic experience

Enduring personality change, present for at least two years, following exposure to catastrophic stress.The stress must be so extreme that it is not necessary to consider personal vulnerability in order to explain its profound effect on the personality.

The disorder is characterized by a hostile or distrustful attitude toward the world, social withdrawal, feelings of emptiness or hopelessness, a chronic feeling of “being on edge” as if constantly threatened, and estrangement.

Post-traumatic stress disorder (F43.1) may precede this type of personality change.

Personality change after:

*concentration camp experiences
*disasters
*prolonged:
*captivity with an imminent possibility of being killed
*exposure to life-threatening situations such as being a victim of terrorism

F43.1Post-traumatic stress disorder

Arises as a delayed or protracted response to a stressful event or situation (of either brief or long duration) of an exceptionally threatening or catastrophic nature, which is likely to cause pervasive distress in almost anyone.

Typical features include episodes of repeated reliving of the trauma in intrusive memories (“flashbacks“), dreams or nightmares, occurring against the persisting background of a sense of “numbness” and emotional blunting, detachment from other people, unresponsiveness to surroundings, anhedonia(inability to feel pleasure), and avoidance of activities and situations reminiscent of the trauma.

There is usually a state of autonomic hyperarousal with hypervigilance, an enhanced startle reaction, and insomnia. Anxiety and depression are commonly associated with the above symptoms and signs, and suicidal ideation is not infrequent. The onset follows the trauma with a latency period that may range from a few weeks to months. The course is fluctuating but recovery can be expected in the majority of cases.

In a small proportion of cases the condition may follow a chronic course over many years, with eventual transition to an enduring personality change (F62.0).

Traumatic neurosis

The term traumatic neurosis designates a psycho-pathological state characterized by various disturbances arising soon or long after an intense emotional shock.

F43.2Adjustment disorders

States of subjective distress and emotional disturbance, usually interfering with social functioning and performance, arising in the period of adaptation to a significant life change or a stressful life event.

The stressor may have affected the integrity of an individual’s social network (bereavement, separation experiences) or the wider system of social supports and values (migration, refugee status), or represented a major developmental transition or crisis (going to school, becoming a parent, failure to attain a cherished personal goal, retirement). Individual predisposition or vulnerability plays an important role in the risk of occurrence and the shaping of the manifestations of adjustment disorders, but it is nevertheless assumed that the condition would not have arisen without the stressor.

The manifestations vary and include depressed mood, anxiety or worry (or mixture of these), a feeling of inability to cope, plan ahead, or continue in the present situation, as well as some degree of disability in the performance of daily routine.

Conduct disorders may be an associated feature, particularly in adolescents. The predominant feature may be a brief or prolonged depressive reaction, or a disturbance of other emotions and conduct.

F05DELIRIUM(Common Cause of Psychotic Symptoms), not induced by alcohol and other psychoactive substances

An etiologically nonspecific organic cerebral syndrome characterized by concurrent disturbances of consciousness and attention, perception, thinking, memory, psychomotor behaviour, emotion, and the sleep-wake schedule. The duration is variable and the degree of severity ranges from mild to very severe.

Incl. acute or subacute:

*Brain Syndrome
*Confusional State (nonalcoholic)
*Infective Psychosis
*Organic Reaction
*Psycho-organic Syndrome

In their current conceptualization of psychosis, both the APA and the World Health Organization define psychosis narrowly by requiring the presence of hallucinations (without insight into their pathologic nature).

‘Insight

In psychotic mental disorders and organic brain syndromes a patient’s insight into whether or not they are ill and therefore requiring treatment may be affected. In depression a person may lack insight into their best qualities and in mania a person may overestimate their wealth and abilities.‘

Examples of hallucinations with preserved insight include the visual hallucinations of migraine aura, sleep transition-related hypnagogic (while falling asleep) and hypnopompic (while waking) hallucinations, and the hallucinated hearing of one’s name being called that many psychiatrically and neurologically healthy individuals experience occasionally.

Littles

Slangterm used by the MPD-DID subculture to indicate child personas of adults who have multiple personalities.

The Meaning of Alters, or Alternates

Although the alters described in DID are sometimes referred to as ego states, Watkins and Watkins23 draw a distinction between the two concepts. They define ego state as an “organized system of behavior and experience whose elements are bound together by some common principle but that is separated from other such states by boundaries that are more or less permeable.”

Watkins and Watkins and others differentiate the concept of alters from that of ego states because the alters in DID have “their own identities, involving a center of initiative and experience, they have a characteristic self representation, which may be different from how the patient is generally seen or perceived, have their own autobiographic memory, and distinguish what they understand to be their own actions and experiences from those done and experienced by other alters, and they have a sense of ownership of their own experiences, actions, and thoughts, and may lack a sense of ownership of and a sense of responsibility for the action, experiences, and thoughts of other alters.”23

Developmental psychologists who adopt the information-processing perspective account for mental development in terms of maturational[Maturation refers to the ways in which we grow and develop throughout the lifespan. ] changes in basic components of a child’s mind. The theory is based on the idea that humans process the information they receive, rather than merely responding to stimuli.

Information Processing: Framework used by cognitive psychologists to explain and describe mental processes. The model likens the thinking process to how a computer works. Just like a computer, the human mind takes in information, organizes and stores it to be retrieved at a later time.)
Automatic processing does not require us to pay attention, nor do we have to deliberately put in effort to control automatic processes. Automatic processing occurs without us giving much thought to it. If we practice something long enough, it becomes automatic. For example, as an experienced bike rider, you may be able to do many bike-riding tasks (i.e. shifting the gears of the bike, braking, and steering) automatically without giving it much thought. You can steer, brake, react to cars on the road, and change speeds because all of the years of practice have made it possible for you to do these things automatically without being consciously aware of what you are doing. Some other examples of automatic processing include playing the piano, walking, and singing a song you are familiar with.

Controlled processes are defined as a process that is under the flexible, intentional control of the individual, that he or she is consciously aware of, and that are effortful and constrained by the amount of attentional resources available at the moment.

Serial–position effect is the tendency of a person to recall the first and last items in a series best, and the middle items worst. … Among earlier list items, the first few items are recalled more frequently than the middle items (the primacy effect).

The levels-of-processing effect, identified by Fergus I. M. Craik and Robert S. Lockhart in 1972, describes memory recall of stimuli as a function of the depth of mental processing. Deeper levels of analysis produce more elaborate, longer-lasting, and stronger memory traces than shallow levels of analysis.

Effortful Processing. Effortful processing is just as the name implies; learning or storing (encoding) that requires attention and effort. We have the capacity to remember lots of things without putting forth any effort.

Psychologists distinguish between three necessary stages in the learning and memory process: encoding, storage, and retrieval (Melton, 1963).

Encoding is defined as the initial learning of information. 

Storage refers to maintaining information over time.

Retrieval is the ability to access information when you need it.

Rehearsal in educational psychology refers to the “cognitive process in which information is repeated over and over as a possible way of learning and remembering it”.

There are two types of memory rehearsal. The first type is called maintenance rehearsal. … However, the material may fade from the working memory quickly.

Chunking is a term referring to the process of taking individual pieces of information (chunks) and grouping them into larger units. By grouping each piece into a large whole, you can improve the amount of information you can remember. Probably the most common example of chunking occurs in phone numbers.Nov 9, 2017

Semantic memory refers to a portion of long-term memory that processes ideas and concepts that are not drawn from personal experience.

 Semantic memory includes things that are common knowledge, such as the names of colors, the sounds of letters, the capitals of countries and other basic facts acquired over a lifetime.Jan 29, 2014