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An Exploration of the Experience of Conflict in Psychiatric Patients Diagnosed with Dissociative Identity Disorder

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An Exploration of the Experience of Conflict in Psychiatric Patients Diagnosed with Dissociative Identity Disorder 1 An exploration of the experience of conflict in psychiatric patients diagnosed with Dissociative Identity Disorder: A collective case study by Lizanda Marais Submitted in partial fulfilment of the degree Masters of Research Psychology in the Department of Psychology at the University of Pretoria Faculty of Humanities Supervisor: Professor Christa Krüger Co-supervisor: Miss Monique Bezuidenhout October 2019 2 Declaration I, Lizanda Marais, declare that this mini-dissertation is my own work. It is submitted to the University of Pretoria for the degree MA Research Psychology. Where other people’s work has been used, this has been referenced in accordance with departmental requirements. This work has not been submitted previously for any degree at the University of Pretoria or any other university. I have not allowed, and will not allow, anyone to copy my work with the intention of passing it off as his or her own work. _______________________________ Signature _______________________________ Date 3 Dedication It gives me great honour to dedicate this research to my friends, family and all the people who supported and encouraged me through this long and testing journey. I am eternally grateful for having such remarkable people in my life. 4 Acknowledgements I would like to express sincere gratitude to the following people: The successful completion of this dissertation owes much to the efforts of Prof. Christa Krüger for her guidance, support, patience and continuous motivation and assistance as a supervisor. Her contribution was invaluable. Her interest and passion in the field of trauma and dissociative disorders made a major impact on me and this body of work. I wish to extend my sincere appreciation to Ms Monique Bezuidenhout for her loyal support, encouragement and continuous guidance throughout and in the finalising of this dissertation. Her contribution was invaluable to this body of work. I am grateful for my family and friends for their love and support throughout this project. 5 Abstract Background: The role and nature of conflict in DID is underexplored beyond theoretical deduction. The present study sought to explore the subjective experience of conflict and the nature of conflict in psychiatric patients diagnosed with DID. Methodology: Qualitative methods were used for this study. First-hand accounts in the form of secondary data were explored – i.e. typed transcriptions of previously recorded in-depth interviews. A collective case study design was used, and the data analysed using thematic analysis alongside the constant comparison analysis method as formulated by Boeije (2002) Findings: Three main themes emerged from the data, viz.: 1) participants’ levels of separateness and unity of the self, 2) participants’ experience of having one or more incompatible and conflicting worldviews about their DID, and 3) the type and nature of conflict that arises between dissociative identities, i.e., conflict of information in awareness, conflicting actions or behaviours, conflicting ways of feelings, conflicting goals, conflicting values, and battle of wills. Conclusion: DID patients experienced distinct and separate parts or identities and these identities were experienced as separate to a lesser or greater extent. The participants’ understanding of the origin of their DID is contextually situated and variable. The conflict between one’s various belief systems may contribute to further dissociation. The study also revealed the nature of the different types of conflict that may be present between participants’ dissociative identities. Conflict between dissociative identities was found to be pervasive and multifaceted. The study provides insight into the complexities of conflict between dissociative identities as well as the role of awareness in DID. Key terms: Dissociative identity disorder, participant experiences, the nature of conflict, psychiatric patients, awareness, case study, thematic analysis. 6 Table of contents Declaration .......................................................................................................................... 2 Dedication ........................................................................................................................... 3 Acknowledgements ............................................................................................................. 4 Abstract ............................................................................................................................... 5 List of figures .................................................................................................................... 10 List of tables .......................................................................................................................11 Chapter 1: Introduction ..................................................................................................... 12 1.1. Introduction and background ................................................................................. 12 1.2. Research problem................................................................................................... 13 1.3. Problem statement .................................................................................................. 14 1.4. Justification, aim and objective of the study .......................................................... 15 1.5. Dissertation structure ............................................................................................. 17 Chapter 2: Review of the literature / theoretical framework ............................................ 19 2.1. Introduction ............................................................................................................ 19 2.2. What is dissociation? ............................................................................................. 19 2.3. Clinical description of dissociative disorders, including DID ............................... 23 2.4. Aetiology of DID / How does DID develop? ......................................................... 29 2.4.1. Schools of thought that inform the aetiological theories of DID .................... 29 2.4.2. Integrated aetiological theories of dissociation and DID ................................ 49 7 2.5. Conflict as covered by the above schools of thought and integrated theories ....... 60 2.6. Conclusion ............................................................................................................. 66 Chapter 3: Design and methods ........................................................................................ 67 3.1. Introduction ............................................................................................................ 67 3.2. Retrospective analysis of previously collected data .............................................. 68 3.3. Qualitative research approach ................................................................................ 68 3.4. Paradigmatic point of departure ............................................................................. 69 3.5. Research design ..................................................................................................... 70 3.6. Sampling method ................................................................................................... 72 3.7. The research participants ....................................................................................... 73 3.8. Data collection ....................................................................................................... 76 3.9. Data analysis .......................................................................................................... 77 3.10. Trustworthiness of the research ........................................................................... 84 3.11. Ethical considerations .......................................................................................... 87 3.12. Conclusion ........................................................................................................... 88 Chapter 4: Findings ........................................................................................................... 89 4.1. Introduction ............................................................................................................ 89 4.2. Theme 1: Participants’ levels of separateness of the self ....................................... 90 4.2.1. Level one: Parts of the self.............................................................................. 91 4.2.2. Level two: Dissociative identities ................................................................... 92 8 4.2.3. Level three: External force that possesses the person ..................................... 94 4.3. Theme 2: Conflicting worldviews used by participants to understand their DID . 96 4.4. Theme 3: Conflict between the dissociative identities......................................... 108 4.4.1. Conflict of information in awareness .............................................................110 4.4.2. Conflicting behaviours ................................................................................... 111 4.4.3. Conflicting ways of feeling ............................................................................117 4.4.4. Conflicting goals ............................................................................................119 4.4.5. Conflicting values between dissociative identities ....................................... 121 4.4.6. The
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