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Section 19
Understanding DID from a Behavior Analytic Perspective, Part 1

Question 19 | Test | Table of Contents

Although Skinner (1953) had suggested we all might display multiple personalities, Kohlenberg (1973) first proposed a learning theory account for a disorder of multiple personality. It can be argued that each of us has differing amounts of variance in our repertoires to the point that a common question may arise: "How many personalities do we actually have?" The question isn't how many personalities does each of us have, but, how many behavioral repertoires are each of us capable of performing or exhibiting? Viewing personality this way, it is obvious that we all perform many personalities, with differing degrees of behavioral excesses and deficits, beyond what is "normal" These variations are caused by differential stimulus control, reinforcement, and punishment contingencies. That is to say, we may behave very differently in a lecture hall than in a church or synagogue. Any individual no doubt behaves very differently when with one's mother than when with friends at a convention. Despite the variability, an observer would still see "It's still Joe" or that there was enough stability or generalization in Joe's personalities across all contexts for Joe to be recognized as the same person.

The Control of Self-Report: On balance, with the behaviors labeled Dissociative Identity Disorder or DID hereafter, the variability between behavioral repertoires is very high, possibly so extreme that the repertoires do not compose one stable personality (Sapulsky, 1995). The person himself or herself may even report being a different person, complete with a different name or "identity" Although the behavioral variability is more extreme here, it is still on a continuum with the average person; we all can exhibit several personalities and there are circumstances under which any person might claim to be a different person (Sackeim & Devanand, 1991). Among the behaviors correlated with a diagnosis of DID, self-report is less controlled by public, environmental events and more controlled by events which are private to the person providing the self-report (Kohlenberg & Tsai, 1991). The most apparent question is: What type of experiences could account for this extreme behavioral variability, in the self-report of being a different person, with differences in sex, age, race, physical appearance, and so forth.

As is commonly known, these individuals frequently report having suffered extreme neglect or abuse as a child (American Psychiatric Association, 1994; Murray, 1994). Reports of a history of childhood abuse are no doubt seen as the defining feature of DID in the minds of many clinicians, as individuals with DID-like behaviors may also display posttraumatic symptoms (American Psychiatric Association, 1994). These reports do not enlighten much because abuse is not rare but the prevalence of these behaviors, while in dispute (American Psychiatric Association, 1994) is not nearly as common as abuse. Some accounts of abuse have been considered suspect because individuals who exhibit these behaviors give highly variable self-reports, and some of these reports of abuse may have been suggested by overzealous therapists (Spanos, 1994).

In relating variations in self-observations and self-reports to the influence of others, the behavior analyst sees the two being related as a straight-forward conclusion. Much self-observation and resultant self-report comes from experiences with, observations of, and inquiries from others (Skinner, 1974). Conceptually, a person with behavior so labeled has had experiences, probably social, that have resulted in extreme behavioral variance as well as self-reports of their behaviors. The behavioral variances are not as readily related to obvious environmental stimuli, however, as they are in the person who does not exhibit the behaviors labeled as being DID (Kohlenberg & Tsai, 1991).

Kohlenberg and Tsai argue that any individual has the experience of "being someone else" as a normal part of a child's imaginary play and these behaviors can be occasioned and reinforced by the public environment. Having different aspects of one's self or "being someone else," accompanied by different subjective states of memory and emotion, because of so behaving, can become a very adaptive behavior, under certain circumstances. When experiencing repeated physical or emotional trauma, being somebody else could provide means of escape or avoidance when no other means of escape or avoidance is attainable (Kohlenberg & Tsai, 1991). The child cannot be unaware of the horrible things happening, but the child can be unaware that it is happening to them. By being someone else who needn't remember the trauma, the child can distance himself or herself from the trauma and still maintain some semblance of a normal emotional relationship with the abuser. From the perspective of the person with the history of being abused, "My dad does bad things to that other little girl, but only because she is so naughty, but my dad loves me and has never done anything bad to me."

The culmination is an individual who never attains a complete personality, self, or an experience of being one coherent 'I' controlled by public and private events. Instead, the individual who experienced the history of abuse has more than one personality or self, controlled by a host of private events (Kohlenberg & Tsai, 1991). In contrast during more normal development, an individual will increasingly engage in being the same person, with these behaviors occasioned and maintained by public and private events; being someone else does not have significant adaptive value.

Differential Remembering: Besides engaging in different personalities, another aspect of the extreme behavioral variance in this disorder is that of amnesia, or an inability to remember beyond what is considered average (American Psychiatric Association, 1994). In other words, besides extreme variability in behavior and self-report of identity, the self-reports of experiences the person has had also varies widely (Coons, 1994). When exhibiting some personalities, the person reports past abuse but not necessarily all the present circumstances. When another behavioral repertoire is exhibited, past abuse may not be reported but the present is reported clearly. It is this behavior that intrigues many. Clinicians and the lay public alike seem to want to know "Is it all in there?". That is, are all the memories and experiences stored somewhere in the mind or brain of this person? From the behavior analytic point of view, remembering (or forgetting) is a behavior, more or less likely to occur as a function of its consequences (Grant, 1982; Grant & Barnet, 1991; Kohlenberg & Tsai, 1991; Skinner, 1974); storage and accessibility are replaced with probability of remembering. With that clarified, one could say that some or most real experiences can be remembered (potentially) and reported; to remember we must arrange the environment to increase the probability that we will behave in the future as we are now behaving (Skinner, 1989). But in these cases, the person is unwilling or unable to remember or report some experiences until that person is in a different situation or the reinforcement contingencies change. Then, the person may change personality repertoires and can remember and report different experiences.

The vivid imagery of the past that is reported by these persons when displaying differential personalities corresponds with Skinner's "conditioned seeing" (Skinner, 1953). A person may come to see stimulus Z, not just when Z is in fact present, but also when other stimuli that have frequently accompanied Z are present. That is, if I can remember and have the emotions of my past, I can come to see aspects of my past; if I do not remember how I felt in the past, I am less likely to see the past again.

This differential remembering/reporting is also on a continuum in degree, not in kind, from the average person's behavior. We all remember, or fail to remember, as a function of discriminative stimuli. These discriminative stimuli, some of which are self-produced in our verbal behavior, and the reinforcement and punishment contingencies in effect at a given time enable our remembering behavior; stimuli guide or facilitate remembering just as stimuli guide or facilitate other behaviors (Donahoe & Palmer, 1994; Grant, 1982; Grant & Barnet, 1991; Skinner, 1974). But these individuals show behavioral variance in remembering and personality in response to highly specific and subtle stimuli, probably more in response to covert behaviors called moods, thoughts, and so forth, than the average person. This difference in controlling factors of these persons' verbal behavior is the key to conceptualizing this behavior pattern (Kohlenberg & Tsai, 1991).

Self-Observation and Controlling Events: To this point, a few of the typical behaviors labeled as DID have been described in behavior analytic terms. While a complete account of the behaviors conceptualized under the DID label is not likely, a probable accounting of most of these behaviors can be framed, using established and understood behavioral processes.

To pursue this further, the variance in self-report of identity and experience by individuals whose behaviors have been labeled as DID may be based disproportionately on inaccurate self-observations made without seeking verification from the social environment. Simply put, such individuals may attend more to their own observations expressed in their own verbal behavior and less upon the observations and reports of others. That is to say, when in Rome and unsure of what to do, persons with DID-like behaviors may not attend to or imitate the behavior of other Romans. Instead, these persons may arrive at an inflexible self-instruction (Fine, 1992) by which to behave or they may attempt to engage in what they judge to be appropriate behavior by trying to observe their own behavior without using social comparisons. Keller and Schoenfeld (1950) described the person as having "the ability to use one's own behavior as the SD for further behavior, verbal or otherwise" (p. 369); here, the person uses his or her own behavior as a guide presumably to a greater extent than the normal individual.

Because abnormality is defined by its context, and because we are frequently less adept at self-observation than we are at observing the behavior of others (Skinner, 1974), this in and of itself could lead to aberrant behavior. But individuals with DID-like behaviors persist in their self-observations and reports, even in the face of contradicting public observations. They claim to be different persons when in fact there is only one and the same person (or body) present. These individuals have dissociated their self-observations and resulting reports from the reports of others. As a result, they have observations that are not as controlled by the public environment but are instead a function of their own distorted verbal governances (Fine, 1992).

Such inaccurate self-observations may be under the control of reinforcement contingencies other than those exerted by other individuals. In the past, the person with the present DID-like behaviors learned to attend to and rely more heavily upon his own observations of how he felt, what he needed, whether he was "good" or "bad" and so forth, (Fine, 1992; Keller & Schoenfeld, 1950). This behavior may have been caused by either neglect or abuse, both of which were possibly delivered without regard to what the child did. The behavior might also have been present before the abuse but only emerged as adaptive responses while the child experienced the abuse (Kohlenberg & Tsai, 1991).
- Phelps, Brady J; Dissociative Identity Disorder: The Relevance Of Behavior Analysis; Psychological Record; Spring 2000; Vol. 50 Issue 2.

Personal Reflection Exercise #5
The preceding section contained information about understanding DID from a behavior analytic perspective.  Write three case study examples regarding how you might use the content of this section in your practice.

Update
Case Report: Anomalous Experience
in a Dissociative Identity
and Borderline Personality Disorder

- Martins, H. A. L., Ribas, V. R., Dos Santos Ribas, K. H., da Fonseca Lins, L., & Mainieri, A. G. (2022). Case Report: Anomalous Experience in a Dissociative Identity and Borderline Personality Disorder. Frontiers in psychiatry, 13, 662290.

Peer-Reviewed Journal Article References:
Bell, M. C. (2018). Winter is coming to the experimental analysis of behavior. Behavior Analysis: Research and Practice, 18(2), 184–192.

Kazemi, E., & Ramirez, V. (2018). Technology and behavior analysis: The past and potential future. Behavior Analysis: Research and Practice, 18(3), 275–276.

Schlinger, H. D., Jr. (2018). The heterodoxy of behavior analysis. Archives of Scientific Psychology, 6(1), 159–168.

QUESTION 19
According to Phelps, how does the behavior analytic perspective address amnesia and differential remembering in clients with DID? To select and enter your answer go to Test.

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