Can Facial Emotion Perception Reflect the Process of Integration in Dissociative Identity Disorder?

facial expressions on lolipops
lolipops with cartoon eyes, personality, dissociative, different moods
Higher integration scores correlated with lower depression severity, PTSD symptom severity, and autobiographical memory disturbances in patients with dissociative identity disorder.

Higher integration scores are associated with fewer psychiatric symptoms and more accurate facial emotion perception in patients with dissociative identity disorder (DID), according to the results of a study published in the Journal of Psychiatric Research.

Considered by some as a coping mechanism related to chronic childhood trauma, DID causes patients to experience their thoughts, emotions, memories, and behaviors as unfamiliar, resulting in a lack of a cohesive sense of self. Recovery may involve the process of integration, which refers to “the development of a sense of self-ownership over one’s mental and bodily experience.”

Lauren A.M. Lebois, PhD, from McLean Hospital, Belmont, Massachusetts, and colleagues enrolled 82 patients (mean age, 40.14±12.87 years; 97.6% female at birth) in a cross-sectional web-based study. To ensure that participants met self-report cutoff scores for posttraumatic stress disorder (PTSD) and DID, the investigators used the PTSD Checklist for Diagnostic and Statistical Manual of Mental Disorders, 5th Edition and Multiscale Dissociation Inventory. Participants completed the Beck Depression Inventory II, Childhood Trauma Questionnaire, and Integration Measure, a measure of self-cohesion. They also underwent the Belmont Emotion Sensitivity Test, which assesses facial emotion perception for expressions of anger, fear, and happiness, using faces morphed with a mixture of 2 emotions.

Related Articles

Higher integration scores correlated with lower depression severity (r(80), −0.34; P =.002), PTSD symptom severity (r(80), −0.23; P =.014), and autobiographical memory disturbance scores (r(80), −0.27; P =.015). Patients with low integration scores performed significantly worse on the medium difficulty facial emotion perception task for anger (M, 0.07; P =.001) and fear (M, 0.09; P <.001) expressions compared with happy faces. However, for patients with high integration scores, there was only a significantly lower accuracy for angry compared with happy trials (M, 0.06; P =.001). The researchers reported that “higher integration scores were associated with better performance to fearful faces compared to individuals with lower integration scores.”

The study authors noted the limitations posed by the cross-sectional and web-based design of the study. They suggest that future research should attempt to replicate these findings in laboratory-based studies.

The investigators concluded that, “emotional conceptualizations entrenched in memory from repeated abuse and neglect may be changed by learning more adaptive conceptualizations over time.” They also suggest that greater accuracy on facial emotion perception tests is a potential objective marker of changes associated with recovery from DID and that integration should be a therapeutic goal of DID treatment.


Lebois LAM, Palermo CA, Scheuer LS, et al. Higher integration scores are associated with facial emotion perception differences in dissociative identity disorder. J Psychiatric Res. 2020;123:164-170.