Harvard Review of Psychiatry, 2016. Bethany L. Brand, PhD, Vedat Sar, MD, Pam Stavropoulos, PhD, Christa Krüger, MB BCh, MMed (Psych), MD, Marilyn Korzekwa, MD,Alfonso Martínez-Taboas, PhD, and Warwick Middleton, MB BS, FRANZCP, MD
By Blue Knot Review editor Jane Macnaught
“Dissociative Identity Disorder (DID) is a complex, posttraumatic, developmental disorder for which we now, after four decades of research, have an authoritative research base, but a number of misconceptualizations and myths about the disorder remain, compromising both patient care and research.
This article examines the empirical literature pertaining to recurrently expressed beliefs regarding DID:
Myth 1) belief that DID is a fad,
Myth 2) belief that DID is primarily diagnosed in North America by DID experts who overdiagnose the disorder,
Myth 3) belief that DID is rare,
Myth 4) belief that DID is an iatrogenic, rather than trauma-based, disorder,
Myth 5) belief that DID is the same entity as borderline personality disorder, and
Myth 6) belief that DID treatment is harmful to patients.
The absence of research to substantiate these beliefs, as well as the existence of a body of research that refutes them, confirms their mythical status. Clinicians who accept these myths as facts are unlikely to carefully assess for dissociation. Accurate diagnoses are critical for appropriate treatment planning. If DID is not targeted in treatment, it does not appear to resolve. The myths we have highlighted may also impede research about DID. The cost of ignorance about DID is high not only for individual patients but for the whole support system in which they reside. Empirically derived knowledge about DID has replaced outdated myths. Vigorous dissemination of the knowledge base about this complex disorder is warranted.”
“Dissociative identity disorder (DID) is defined in the fifth edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-5) as an identity disruption indicated by the presence of two or more distinct personality states (experienced as possession in some cultures), with discontinuity in sense of self and agency, and with variations in affect, behavior, consciousness, memory, perception, cognition, or sensory-motor functioning.1 Individuals with DID experience recurrent gaps in autobiographical memory. The signs and symptoms of DID may be observed by others or reported by the individual. DSM-5 stipulates that symptoms cause significant distress and are not attributable to accepted cultural or religious practices. Conditions similar to DID but with less-than-marked symptoms (e.g., subthreshold DID) are classified among “other specified dissociative disorders.”
"DID is a complex, posttraumatic developmental disorder.2,3 DSM-5 specifically locates the dissociative disorders chapter after the chapter on trauma- and stressor-related disorders, thereby acknowledging the relationship of the dissociative disorders to psychological trauma.” p. 257
“Current debates about the validity and etiology of DID echo early debates about hysteria and also other trauma-based phenomena such as dissociative amnesia. Historically, trauma has stirred debate within and outside the mental health field; periods of interest in trauma have been followed by disinterest and disavowal of its prevalence and impact.” 6,23,24 p. 258
“In this climate of renewed receptivity to the study of trauma and its impact, research in dissociation and DID has expanded rapidly in the 40 years spanning 1975 to 2015.14,34 Researchers have found dissociation and dissociative disorders around the world.” 3,12,35–45 p. 258
“Notwithstanding the upsurge in authoritative research on DID, several notions have been repeatedly circulated about this disorder that are inconsistent with the accumulated findings on it. We argue here that these notions are misconceptions or myths. We have chosen to limit our focus to examining myths about DID, rather than dissociative disorders or dissociation in general. Careful reviews about broader issues related to dissociation and DID have recently been published. 47–49 The purpose of this article is to examine some misconceptions about DID in the context of the considerable empirical literature that has developed about this disorder.” p.258
(Read the complete paper for an expanded explanation of the six myths about dissociative identity disorder.)
The Cost Of Myths And Ignorance About DID
“…current research indicates that while approximately 1% of the general population suffers from DID, the disorder remains undertreated and underrecognized. The average DID patient spends years in the mental health system before being correctly diagnosed.4,71,72,76,79 These patients have high rates of suicidal and self-destructive behavior, experience significant disability, and often require expensive and restrictive treatments such as inpatient and partial hospitalization.64,162,163 Studies of treatment costs for DID show dramatic reductions in overall cost of treatment, along with reductions in utilization of more restrictive levels of care, after the correct diagnosis of DID is made and appropriate treatment is initiated.164–166
Delay in recognition and adequate treatment of DID likely prolongs the suffering and disability of DID patients. Younger DID patients appear to respond more rapidly to treatment than do older adults,167 which suggests that years of misdirected treatment exact a high personal cost from patients.166 Needless to say, if clinicians do not recognize the disorder, they cannot provide treatment consistent with expert guidelines for DID.” p. 265
“An enduring interest in DID is apparent in the solid and expanding research base about the disorder. DID is a legitimate and distinct psychiatric disorder that is recognizable worldwide and can be reliably identified in multiple settings by appropriately trained researchers and clinicians." The research shows that DID is a trauma-based disorder that generally responds well to treatment consistent with DID treatment guidelines.
Our findings have a number of clinical and research implications. Clinicians who accept as facts the myths explored above are unlikely to carefully assess for dissociation. Accurate diagnoses are critical for appropriate treatment planning. If DID is not targeted in treatment, it does not appear to resolve.161,168The myths we have highlighted may also impede research about DID. The cost of ignorance about DID is high not only for individual patients, but for the whole support system in which they live (e.g., loved ones, health systems, and society). Empirically derived knowledge about DID has replaced outdated myths, and for this reason vigorous dissemination of the knowledge base about this complex disorder is warranted.” p. 265-6
Read the full article here: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4959824/
Brand, B. L., Sar, V., Stavropoulos, P., Krüger, C., Korzekwa, M., Martínez-Taboas, A., & Middleton, W. (2016). Separating Fact from Fiction: An Empirical Examination of Six Myths About Dissociative Identity Disorder. Harvard Review of Psychiatry, 24(4), 257–270. http://doi.org/10.1097/HRP.0000000000000100
*Prior to being renamed dissociative identity disorder, DID was referred to as “multiple personality disorder.” Dissociated personality states are referred to by various names, including identities, dissociated self-states, parts, and alters.
This is an abridged list of references from this version, for full list go to full article.
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