Article
A Markov chain approach to model contradictory effects in a case of dissociative identity disorder treatment
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Authors
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Ulrich Elbing
- Department of Arts Therapy, Nuertingen-Geislingen University, Nürtingen, Germany
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Sebastian Appelbaum
- Department for Psychology and Psychotherapy, Witten/Herdecke University, Witten, Germany
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Thomas Ostermann
- Department for Psychology and Psychotherapy, Witten/Herdecke University, Witten, Germany
| Published: | August 27, 2018 |
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Outline
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Introduction: Dissociative identity disorders (DID), also referred to as multiple personality disorder, are characterized by at least two distinct and relatively enduring personality states. Associated conditions often include borderline personality disorder, post-traumatic stress disorder, depression, substance misuse disorder, self-harm, or anxiety. Contradictory effects of Lorazepam on challenging behavior of DID patients with intellectual disability are well known to experienced practitioners but rarely published with empirical data. The aim of this study was to describe a patient case of DID combined with delay in speech and communication skills using daily diary data modeled by a Markov chain approach.
Methods: The effects of Lorazepam are tested by a natural single case experiment with an ABA-design, using systematically documented diary data consisting of a 76 days (A), 113 days (B) and 78 days (A’) time line with 4 time points of standardized behavior notation per day. The medication effects were modelled with Markov chains using tests to detect differences in transitions between the time frames.
Results: The contradictory effects of Lorazepam result in a highly significant increase of fretful and stressed behavior (Chi²-Test; p < 0.0001) and additionally a significantly reduced stability of mood and behavior modelled by the Markov chains.
Discussion: This paper presents the possibilities of using Markov chains in clinical outcome research.Our results are in line with reports and findings about the effects of psychotropic medication in patients with DID. The effects of a DID in patients with intellectual disabilities may be a helpful explanation of the discussed contradictory medication responses.
Conclusion: This case study is an example of how to apply stochastic process analysis to a pharmacologically important area of health services research.
The authors declare that they have no competing interests.
The authors declare that an ethics committee vote is not required.
