PODS, Positive Outcomes for Dissociative Survivors, maintains a regularly updated list of scholarly articles on DID. There are far too many to list here, articles on DID published in peer-reviewed journals number in the thousands. This is a selection posted mainly to contend with disinformation in the media.
DID is not a purely Western Phenomena
DID is found throughout the world, even among populations who have no cultural model nor prior knowledge of the condition.
The results of our study support the epidemiological prediction of the trauma model of dissociation and are not consistent with the sociocognitive model. Pathological dissociation was reported by Chinese respondents, despite the lack of contamination, role demands, and iatrogenic suggestion in China. Pooling the 1,345 Chinese respondents, a dissociative disorder of some type was diagnosed in 24 individuals by the Dissociative Disorders Interview Schedule, while 15 respondents were in the dissociative taxon on the Dissociative Experiences Scale. There were three individuals with dissociative identity disorder.
This study attempted to determine the prevalence of dissociative identity disorder in the general population. The Dissociative Experiences Scale (DES) was administered to 994 subjects in 500 homes who constituted a representative sample of the population of Sivas City, Turkey. The mean DES score was 6.7 ± 6.1 (mean ± SD). Of the 62 respondents who scored above 17 on the DES, 32 (51.6%) could be contacted during the second phase of the study. They were matched for age and gender with a group of respondents who scored below 10 on the scale, and the Dissociative Disorders Interview Schedule (DDIS) was then administered to both groups. Seventeen subjects (1.7%) received a diagnosis of dissociative disorder according to the structured interview. In the third phase, eight of 17 subjects who had a dissociative disorder on the structured interview could be contacted for a clinical evaluation. They were matched with a nondissociative control group and interviewed by a clinician blind to the structured interview diagnosis. Four of eight subjects were diagnosed clinically with dissociative identity disorder, yielding a minimum prevalence of 0.4%. Dissociative identity disorder is not rare in the general population. Self-rating instruments and structured interviews can be used successfully for screening these cases. Our data, derived from a population with no public awareness about dissociative identity disorder and no exposure to systematic psychotherapy, suggest that dissociative identity disorder cannot be considered simply an iatrogenic artifact, a culture-bound syndrome, or a phenomenon induced by media influences.
Presented in part at the Fall Conference of the International Society for the Study of Dissociation, San Francisco, CA, November 8, 1996.
Department of Psychiatry, All India Institute of Medical Sciences, New Delhi.
Three consecutive cases of multiple personality disorder seen over a period of 3 years at a psychiatric clinic in India are reported. The prevalence of this disorder at the clinic is about 0.15/1,000 patients per year. The authors discuss the infrequency of this diagnosis in India in contrast to the frequent diagnosis of possession syndrome for patients who have many of the same symptoms. Transcultural differences in diagnostic practices are also discussed.
Prevalence and Buttresses of Validity
Spiegel D, Loewenstein RJ, Lewis-Fernández R, Sar V, Simeon D, Vermetten E, Cardeña E, Dell PF.
Department of Psychiatry, Stanford University, Palo Alto, California. email@example.com.
Background: We present recommendations for revision of the diagnostic criteria for the Dissociative Disorders (DDs) for DSM-5. The periodic revision of the DSM provides an opportunity to revisit the assumptions underlying specific diagnoses and the empirical support, or lack of it, for the defining diagnostic criteria. Methods: This paper reviews clinical, phenomenological, epidemiological, cultural, and neurobiological data related to the DDs in order to generate an up-to-date, evidence-based set of DD diagnoses and diagnostic criteria for DSM-5. First, we review the definitions of dissociation and the differences between the definitions of dissociation and conceptualization of DDs in the DSM-IV-TR and the ICD-10, respectively. Also, we review more general conceptual issues in defining dissociation and dissociative disorders. Based on this review, we propose a revised definition of dissociation for DSM-5 and discuss the implications of this definition for understanding dissociative symptoms and disorders. Results: We make the following recommendations for DSM-5: 1. Depersonalization Disorder (DPD) should include derealization symptoms as well. 2. Dissociative Fugue should become a subtype of Dissociative Amnesia (DA). 3. The diagnostic criteria for DID should be changed to emphasize the disruptive nature of the dissociation and amnesia for everyday as well as traumatic events. The experience of possession should be included in the definition of identity disruption. 4. Dissociative Trance Disorder should be included in the Unspecified Dissociative Disorder (UDD) category. Conclusions: There is a growing body of evidence linking the dissociative disorders to a trauma history, and to specific neural mechanisms. Depression and Anxiety 28:E17-E45, 2011. © 2011 Wiley Periodicals, Inc.
Department of Psychiatry and Psychotherapy, Medizinische Hochschule Hannover, Germany.
The aim of the study was to determine the frequency of dissociative disorders among psychiatric inpatients in Germany and to investigate the relationship between childhood trauma and dissociation. The German version of the Dissociative Experiences Scale (DES), the Fragebogen für Dissoziative Symptome (FDS), was used to screen 115 consecutive inpatients admitted to the psychiatric clinic of a university hospital. Patients with FDS scores higher than 20 were interviewed by a trained clinician, using the German translation of the Structured Clinical Interview for DSM-IV Dissociative Disorders (SCID-D-R). The German version of the Childhood Trauma Questionnaire (CTQ) was administered to investigate prevalence of childhood trauma and relations between childhood trauma and dissociation in adult life. Twenty-five of the 115 patients (21.7%) had a score higher than 20 on the FDS. Of these, 15 patients were interviewed with the SCID-D-R. One patient was diagnosed with a dissociative identity disorder, three with dissociative disorders not otherwise specified, and one patient with depersonalization disorder. All diagnoses were confirmed clinically. A significant positive relationship was found between the severity of childhood trauma and dissociation. Dissociative disorders are common among German psychiatric inpatients. Clinicians who work in psychiatric inpatient units should be mindful of these disorders.
Psychiatric Hospital Willibrord, Heiloo, The Netherlands.
OBJECTIVE: The goal of this study was to determine the frequency of dissociative disorders in Dutch psychiatric inpatients.
METHOD: During a period of 12 months, 122 consecutively admitted adult psychiatric patients were screened with the Dissociative Experiences Scale. Patients scoring 25 and higher and a random selection of patients scoring lower than 25 were blindly interviewed with the Structured Clinical Interview for DSM-IV Dissociative Disorders, Revised. Interviews were scored independently by a blind rater.
RESULTS: Ten (8%) of the 122 patients were diagnosed as having a dissociative disorder; two (2%) were diagnosed as having a dissociative identity disorder. Two patients (2%) had factitious dissociative identity disorder.
CONCLUSIONS: The rate of dissociative disorders in this group of Dutch patients is comparable to the rates reported in other European studies but lower than rates reported in North American studies.
Sar V, Koyuncu A, Ozturk E, Yargic LI, Kundakci T, Yazici A, Kuskonmaz E, Aksüt D.
Department of Psychiatry, Clinical Psychotherapy Unit and Dissociative Disorders Program, Medical Faculty of Istanbul, University of Istanbul, Istanbul, Turkey. firstname.lastname@example.org
Fifteen emergency unit patients (34.9% of the 43 evaluated participants) were diagnosed as having a dissociative disorder. Six (14.0%) patients had dissociative identity disorder, 6 (14.0%) had dissociative disorder not otherwise specified, and 3 (7.0%) had dissociative amnesia. The average DES score of dissociative patients was 43.7. A majority of them had comorbid major depression, somatization disorder, and borderline personality disorder. Most of the patients with dissociative disorder reported auditory hallucinations, symptoms associated with psychogenic amnesia, flashback experiences, and childhood abuse and/or neglect.
CONCLUSIONS: Dissociative disorders constitute one of the diagnostic groups with high relevance in emergency psychiatry.
Carter Memorial Hospital, Indianapolis, Indiana 46202.
To study the clinical phenomenology of multiple personality, 50 consecutive patients with DSM-III multiple personality disorder were assessed using clinical history, psychiatric interview, neurological examination, electroencephalogram, MMPI, intelligence testing, and a variety of psychiatric rating scales. Results revealed that patients with multiple personality are usually women who present with depression, suicide attempts, repeated amnesic episodes, and a history of childhood trauma, particularly sexual abuse. Also common were headaches, hysterical conversion, and sexual dysfunction. Intellectual level varied from borderline to superior. The MMPI reflected underlying character pathology in addition to depression and dissociation. Significant neurological or electroencephalographical abnormalities were infrequent. These data suggest that the etiology of multiple personality is strongly related to childhood trauma rather than to an underlying electrophysiological dysfunction.
Trauma Recovery Center, Psychotherapy Resources of Norfolk, Inc., Virginia 23510-1309, USA.
Forty-two outpatients with dissociative identity disorder (DID) and 16 outpatients with dissociative disorder not otherwise specified (DDNOS) were administered the Millon Clinical Multiaxial Inventory-II (MCMI-II), the Minnesota Multiphasic Personality Inventory-2 (MMPI-2), and the Dissociative Experiences Scale (DES). DID patients manifested severe personality pathology (BR > 84) on a mean of 4.0 MCMI-II scales: avoidant (76%), self-defeating (68%), borderline (53%), and passive-aggressive (45%). DDNOS cases had severe personality pathology on fewer MCMI-II scales (mean = 1.69): avoidant (50%) and self-defeating (31%). The DID and DDNOS groups differed in their scores on the DES (means = 54.9 vs. 25.9), the PK-PTSD scale of the MMPI-2 (means = 33.6 vs. 21.7), and in the incidence of severe borderline pathology (53% vs. 6%). These data on personality pathology in DID patients are virtually identical to those of seven previous studies of personality pathology in chronic PTSD patients (i.e., avoidant, self-defeating, borderline, and passive-aggressive). Such robust convergence of findings supports the construct validity of DID as a form of posttraumatic disorder and suggests that there is a quite predictable personologic core to the clinical picture of severely traumatized individuals.
Department of Psychology, Texas A&M University, College Station 77843-4235, USA. email@example.com
According to the sociocognitive model of dissociative identity disorder (DID; formerly, multiple personality disorder), DID is not a valid psychiatric disorder of posttraumatic origin; rather, it is a creation of psychotherapy and the media. Support for the model was recently presented by N.P. Spanos (1994). In this article, the author reexamines the evidence for the model and concludes that it is based on numerous false assumptions about the psychopathology, assessment, and treatment of DID. Most recent research on the dissociative disorders does not support (and in fact disconfirms) the sociocognitive model, and many inferences drawn from previous research appear unwarranted. No reason exists to doubt the connection between DID and childhood trauma. Treatment recommendations that follow from the sociocognitive model may be harmful because they involve ignoring the posttraumatic symptomatology of persons with DID.
Neurobiological Approaches to Understanding DID
Kelly A. Forrest
University of Washington, Bothell, Washington
3 September 1999.
Abstract: This article elaborates on Putnam’s “discrete behavioral states” model of dissociative identity disorder (Putnam, 1997) by proposing the involvement of the orbitalfrontal cortex in the development of DID and suggesting a potential neurodevelopmental mechanism responsible for the development of multiple representations of self. The proposed “orbitalfrontal” model integrates and elaborates on theory and research from four domains: the neurobiology of the orbitalfrontal cortex and its protective inhibitory role in the temporal organization of behavior, the development of emotion regulation, the development of the self, and experience-dependent reorganizing neocortical processes. The hypothesis being proposed is that the experience-dependent maturation of the orbitalfrontal cortex in early abusive environments, characterized by discontinuity in dyadic socioaffective interactions between the infant and the caregiver, may be responsible for a pattern of lateral inhibition between conflicting subsets of self-representations which are normally integrated into a unified self. The basic idea is that the discontinuity in the early caretaking environment is manifested in the discontinuity in the organization of the developing child’s self.
Conflation of DID with Schizophrenia and other Cultural Factors
The syndrome of multiple (dissociated) personality fell into disrepute around 1910. This has been attributed to loss of interest in hypnosis; psychiatrists believed the syndrome resulted from hypnosis and that they were duped. However, around 1910 an important event occurred in psychiatry: Bleuler introduced the term “schizophrenia’ to replace “dementia praecox.’ This factor also played a role in the decline of recognition of the multiple personality syndrome, and many of these cases were diagnosed as schizophrenia. A review of Index Medicus from 1903 through 1978 shows a dramatic decline in the number of reports of multiple personality after the diagnosis of schizophrenia “caught on,’ especially in the United States. A review of clinical reports indicates that many patients with multiple personality had been diagnosed and treated as schizophrenics.
College of Criminal Justice, New York, NY 10019, USA. firstname.lastname@example.org
Multiple Personality Disorder (MPD), now known as Dissociative Identity Disorder (DID), has been of great interest to the public for over a century. Case histories of MPD can be found in the literature as far back as the eighteenth century; nevertheless, publications from the latter part of the nineteenth century best describe this disorder as we know it today. This paper traces the case history literature of DID (MPD) from the earliest period to the present. This is done in such a way as to illuminate the basic theoretical and epistemological issues that are necessary to understand the process of dissociation (both normal, and abnormal aspects) and the role of hypnosis and its relationship to organic and ‘hysterical epilepsy.’ The theories of Fanet, Prince and Sidis are the major authorities discussed. The paper concludes with a discussion of the danger inherent in fostering a deterministic or reductionistic theory of consciousness.