Dissociative Identity Disorder (DID), as defined by the American Psychiatric Association's Diagnostic and Statistical Manual of Mental Disorders (DSM), is a psychiatric diagnosis that describes a condition in which a single person displays multiple distinct identities or personalities, each with its own pattern of perceiving and interacting with the environment. The diagnosis requires that at least two personalities routinely take control of the individual's behavior with an associated memory loss that goes beyond normal forgetfulness; in addition, symptoms cannot be due to substance abuse or medical condition. Earlier versions of the DSM named the condition multiple personality disorder (MPD), and the term is still used by the ICD-10. There is controversy around the existence, the possible causes, the prevalence across cultures, and the epidemiology of the condition.
Others believe DID is created iatrogenically by therapists using certain treatment techniques with suggestible patients, though this idea is neither confirmed nor universally accepted.
Diagnosis should be performed by a psychiatrist or psychologist who may use specially designed interviews (such as the SCID-D) and personality assessment tools to evaluate a person for a dissociative disorder.
The psychiatric history of individuals diagnosed with DID frequently contain multiple previous diagnoses of various mental disorders and treatment failures. The belief by some doctors that the diagnosis is fallacious may contribute to the frequency of its misdiagnosis. DID is frequently misdiagnosed as bipolar disorder due to mood changes between alter states being mistaken for the cyclical mood changes accompanying bipolarity. Another frequent misdiagnosis is psychotic disorder as dialogues between alters may be mistaken for auditory hallucinations.
The Dissociative Disorders Interview Schedule (DDIS) is a highly structured interview which discriminates between various DSM-IV diagnoses. The DDIS can usually be administered in 30-45 minutes.
The Dissociative Experiences Scale (DES) is a simple, quick, and validated questionnaire that has been widely used to screen for dissociative symptoms. Tests such as the DES provide a quick method of screening subjects so that the more time-consuming structured clinical interview can be used in the group with high DES scores. Depending on where the cutoff is set, people who would subsequently be diagnosed can be missed. An early recommended cutoff was 15-20 and in one study a DES with a cutoff of 30 missed 46 percent of the positive SCID-D diagnoses and a cutoff of 20 missed 25%. The reliability of the DES in non-clinical samples has been questioned. There is also a DES scale for children and DES scale for adolescents. One study argued that old and new trauma may interact, causing higher DID item test scores.
|India||0.015%||Adityanjee et al (1989)|
|China||0.4%||Xiao et al (2006)|
|Germany||0.9%||Gast et al (2001)|
|The Netherlands||2%||Friedl & Draijer (2000)|
|U.S.||10%||Bliss & Jeppsen (1985)|
|U.S.||6-8%||Ross et al (1992)|
|U.S.||6-10%||Foote et al. (2006)|
|Turkey||14%||Sar et al (2007)|
Figures from the general population show less diversity:
|Turkey (male)||0.4%||Akyuz et al (1999)|
|Turkey (female)||1.1%||Sar et al (2007)|
Dissociative identity disorder can be found in a sizable minority of patients in drug abuse treatment facilities.
Some of these hypnotherapists reported treating people with symptoms that might now be diagnosed as DID. The 19th century saw a number of reported cases of multiple personalities which Rieber estimated would be close to 100. Epilepsy was seen as a factor in some cases and discussion of this connection continues into the present era.
By the late 19th century there was a general realization that emotionally traumatic experiences could cause long-term disorders which may manifest with a variety of symptoms. Between 1880 and 1920, many great international medical conferences devoted a lot of time to sessions on dissociation. It was in this climate that Jean-Martin Charcot introduced his ideas of the impact of nervous shocks as a cause for a variety of neurological conditions. One of Charcot's students, Pierre Janet, took these ideas and went on to develop his own theories of dissociation.
In the early 20th century interest in dissociation and MPD waned for a number of reasons. After Charcot's death in 1893, many of his "hysterical" patients were exposed as frauds and Janet's association with Charcot tarnished his theories of dissociation. Sigmund Freud recanted his earlier emphasis on dissociation and childhood trauma. Freud, a man who actively promoted his ideas and enlisted the help of others, won out over the "lone wolf" Janet who did not train students in a teaching hospital. Psychologists found that science was hard to reconcile with a "soul" or an "unconscious".
In 1910, Eugen Bleuler introduced the term "schizophrenia" to replace "dementia praecox" and a review of the Index Medicus from 1903 through 1978 showed a dramatic decline in the number of reports of multiple personality after the diagnosis of schizophrenia "caught on," especially in the United States. A number of factors helped create a large climate of skepticism and disbelief; paralleling the increased suspicion of MPD was the decline of interest in dissociation as a laboratory and clinical phenomenon.
Starting in about 1927, there was a large increase in the number of reported cases of schizophrenia, which was matched by an equally large decrease in the number of multiple personality reports. Bleuler also included multiple personality in his category of schizophrenia. It was found in the 1980's that MPD patients are often misdiagnosed as suffering from schizophrenia.
The public, however, were exposed to psychological ideas which took their interest. Mary Shelley's Frankenstein, Robert Louis Stevenson's Strange Case of Dr Jekyll and Mr Hyde, and many short stories by Edgar Allan Poe, had a formidable impact. In 1957, with the publication of the book The Three Faces of Eve, and the popular movie which followed it, the American public's interest in multiple personality was revived. Multiple personality disorder began to emerge as a separate disorder in the 1970's when an initially small number of clinicians worked to re-establish MPD as a legitimate diagnosis.
In 1974, the highly influential book Sybil was published and six years later the diagnosis of multiple personality disorder was included in the DSM. As media coverage spiked, diagnoses climbed. There were 200 reported cases of MPD from 1880 to 1979, and 20,000 from 1980 to 1990. Joan Acocella reports that 40,000 cases were diagnosed from 1985 to 1995. The majority of diagnoses are made in North America, particularly the United States, and in English-speaking countries more generally with reports recently emerging from other countries.
One of the primary reasons for the ongoing recategorization of this condition is that there were once so few documented cases (research in 1944 showed only 76) of what was once referred to as multiple personality. Dissociation is recognized as a symptomatic presentation in response to trauma, extreme emotional stress, and, as noted, in association with emotional dysregulation and borderline personality disorder. In one study, DID was found to be a genuine disorder with a constant set of core features.
The DSM-II used the term multiple personality disorder, the DSM-III the diagnosis with the other four major dissociative disorders, and the DSM-IV-TR categorizes it as dissociative identity disorder. The ICD-10 continues to list the condition as multiple personality disorder.
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Apr 02, 2007; Markets: Stocks rose, fell and then recovered Friday--just as they did over the course of the first quarter, as Wall Street...