Dissociative identity disorder
[10][11](p334) Across diverse geographic regions, 90% of people diagnosed with dissociative identity disorder report experiencing multiple forms of childhood abuse, such as rape, violence, neglect, or severe bullying.
[33] Presentations of dissociation in people with schizophrenia differ from those with DID as not being rooted in trauma, and this distinction can be effectively tested, although both conditions share a high rate of auditory hallucinations in the form of voices.
[39][40][41] The DSM-5-TR states that "early life trauma (e.g., neglect and physical, sexual, and emotional abuse, usually before ages 5-6 years) represents a major risk factor for dissociative identity disorder.
[25] Possibly due to developmental changes and a more coherent sense of self past age 6-9 years, the experience of extreme trauma may result in different, though also complex, dissociative symptoms, identity disturbances and trauma-related disorders.
[25] Relationships between childhood abuse, disorganized attachment, and lack of social support are thought to be common risk factors leading to dissociative identity disorder.
[48] Paris states that the trauma model of dissociative identity disorder increased the appeal of the diagnosis among health care providers, patients and the public as it validated the idea that child abuse had lifelong, serious effects.
Most previous examples of "multiples" such as Chris Costner Sizemore, whose life was depicted in the book and film The Three Faces of Eve, reported no memory of childhood trauma.
[24] That a large proportion of cases are diagnosed by specific health care providers, and that symptoms have been created in nonclinical research subjects given appropriate cueing has been suggested as evidence that a small number of clinicians who specialize in DID are responsible for the creation of alters through therapy.
[25] Persistence and consistency of identities and behavior, amnesia, measures of dissociation or hypnotizability and reports from family members or other associates indicating a history of such changes can help distinguish DID from other conditions.
[67] Psychiatrist Joel Paris notes that the idea that a personality is capable of splitting into independent alters is an unproven assertion at odds with research in cognitive psychology.
[71][72][73][74] Proponents of the sociogenic model dispute that dissociative identity disorder is an organic response to trauma, but believe it is a socially constructed behavior and psychic contagion.
[29] The empirical research includes the longitudinal TOP DD treatment study, which found that patients showed "statistically significant reductions in dissociation, PTSD, distress, depression, hospitalisations, suicide attempts, self-harm, dangerous behaviours, drug use, and physical pain" and improved overall functioning.
Those who suffer from dissociative identity disorder have commonly been subject to actual abuse (sexual, physical, emotional, financial) by therapists, family, friends, loved ones, and community members.
[80] Brief treatment due to managed care may be difficult, as individuals diagnosed with DID may have unusual difficulties in trusting a therapist and take a prolonged period to form a comfortable therapeutic alliance.
[17] A 1996 essay suggested three possible causes for the sudden increase of DID diagnoses, among which the author suspects the first being most likely:[87] Dissociative disorders were excluded from the Epidemiological Catchment Area Project.
[98] Whereas Kraepelin's natural disease entity was anchored in the metaphor of progressive deterioration and mental weakness and defect, Bleuler offered a reinterpretation based on dissociation or "splitting" (Spaltung) and widely broadened the inclusion criteria for the diagnosis.
[100] A number of factors helped create a large climate of skepticism and disbelief; paralleling the increased suspicion of DID was the decline of interest in dissociation as a laboratory and clinical phenomenon.
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.
The APA wrote in the second edition of the DSM: "In the dissociative type, alterations may occur in the patient's state of consciousness or in his identity, to produce such symptoms as amnesia, somnambulism, fugue, and multiple personality.
Describing what Robert Rieber called "the third most famous of multiple personality cases,"[106] it presented a detailed discussion of the problems of treatment of "Sybil Isabel Dorsett", a pseudonym for Shirley Ardell Mason.
In the opinion of McGill University psychiatrist Joel Paris, this inadvertently legitimized them by forcing textbooks, which mimicked the structure of the DSM, to include a separate chapter on them and resulted in an increase in diagnosis of dissociative conditions.
Once a rarely occurring spontaneous phenomenon (research in 1944 showed only 76 cases),[112] the diagnosis became "an artifact of bad (or naïve) psychotherapy" as patients capable of dissociating were accidentally encouraged to express their symptoms by "overly fascinated" therapists.
[113] In a 1986 book chapter (later reprinted in another volume), philosopher of science Ian Hacking focused on multiple personality disorder as an example of "making up people" through the untoward effects on individuals of the "dynamic nominalism" in medicine and psychiatry.
With the invention of new terms, entire new categories of "natural kinds" of people are assumed to be created, and those thus diagnosed respond by re-creating their identity in light of the new cultural, medical, scientific, political and moral expectations.
[121] A 2006 study compared scholarly research and publications on DID and dissociative amnesia to other mental health conditions, such as anorexia nervosa, alcohol use disorder, and schizophrenia from 1984 to 2003.
"[118] The public's long fascination with DID has led to a number of different books and films,[5](p 169) with many representations described as increasing stigma by perpetuating the myth that people with mental illness are usually dangerous.
[128][127] United States of Tara was reported to be the first US television series with DID as its focus, and a professional commentary on each episode was published by the International Society for the Study of Trauma and Dissociation.
[110][141] In the United States dissociative identity disorder has previously been found to meet the Frye test as a generally accepted medical condition, and the newer Daubert standard.
[148] Psychologist Naomi Torres-Mackie, head of research at The Mental Health Coalition, has stated "All of a sudden, all of my adolescent patients think that they have this, and they don't ... Folks start attaching clinical meaning and feeling like, 'I should be diagnosed with this.
[5][155] Therapists may discourage people with DID from media work due to concerns that they may feel exploited or traumatized, for example as a result of demonstrating switching between personality states to entertain others.
