For all in-house training enquiries, click here or call us on (02) 8920 3611 to speak to our training team. Download our In-house Training Booklet here

Blue Knot Foundation Blog

Check out our recent blog posts to stay up to date with our work, latest research and articles curated by the Blue Knot Foundation Marketing & Communications team. Should you have any suggestions or contributions please contact us via email: marketing@blueknot.org.au.

Articles

15

"Separating Fact from Fiction: An Empirical Examination of Six Myths About Dissociative Identity Disorder"

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


This article is an abridged version of the original and includes direct extracts.

By Blue Knot Review editor Jane Macnaught

Abstract

“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 Empirically derived knowledge about DID has replaced outdated myths.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.”


 myths about DID Dissociate Identity Disorder“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


Conclusion

“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

 

 


Footnote
*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.

References:  
This is an abridged list of references from this version, for full list go to full article.
1. American Psychiatric Association. Diagnostic and statistical manual of mental disorders. 5th ed Arlington, VA: APA, 2013.
2. Putnam FW. Dissociation in children and adolescents: a developmental perspective. New York: Guilford, 1997.
3. Simeon D, Loewenstein RJ. Dissociative disorders. In: Sadock BJ, Sadock VA, Ruiz P, editors. , eds. Kaplan and Sadock’s comprehensive textbook of psychiatry. 9th ed Philadelphia: Lippincott Williams & Wilkens, 2009;1965–2026.
4. Putnam FW, Guroff JJ, Silberman EK, Barban L, Post RM. The clinical phenomenology of multiple personality disorder: review of 100 recent cases. J Clin Psychiatry 1986;47:285–93. [PubMed]
6. Herman JL. Trauma and recovery. New York: Basic, 1992.
12. Middleton W, Butler J. Dissociative identity disorder: an Australian series. Aust N Z J Psychiatry1998;32:794–804. [PubMed]
14. Dorahy MJ, Brand BL, Şar V, et al. Dissociative identity disorder: an empirical overview. Aust N Z J Psychiatry 2014;48:402–17. [PubMed]
23. Herman JL. Complex PTSD: a syndrome in survivors of prolonged and repeated trauma. In: Everly GS Jr, Lating JM, editors. , eds. Psychotraumatology: key papers and core concepts in post-traumatic stress. New York: Plenum, 1995;87–100.
24. Chu JA. Rebuilding shattered lives: treating complex PTSD and dissociative disorders 2nd ed. Hoboken, NJ: Wiley, 2011.
34. Dalenberg C, Loewenstein R, Spiegel D, et al. Scientific study of the dissociative disorders. Psychother Psychosom 2007;76:400–1. [PubMed]
35. Stein DJ, Koenen KC, Friedman MJ, et al. Dissociation in posttraumatic stress disorder: evidence from the World Mental Health Surveys. Biol Psychiatry 2013;73:302–12. [PMC free article] [PubMed]
36. Brand BL, Lanius R, Vermetten E, Loewenstein RJ, Spiegel D. Where are we going? An update on assessment, treatment, and neurobiological research in dissociative disorders as we move toward the DSM-5. J Trauma Dissociation 2012;13:9–31. [PubMed]
37. Foote B, Smolin Y, Kaplan M, Legatt ME, Lipschitz D. Prevalence of dissociative disorders in psychiatric outpatients. Am J Psychiatry 2006;163:623–9. [PubMed]
38. Friedl MC, Draijer N. Dissociative disorders in Dutch psychiatric inpatients. Am J Psychiatry2000;157:1012–3. [PubMed]
39. Gast U, Rodewald F, Nickel V, Emrich HM. Prevalence of dissociative disorders among psychiatric inpatients in a German university clinic. J Nerv Ment Dis 2001;189:249–57. [PubMed]
40. Horen SA, Leichner PP, Lawson JS. Prevalence of dissociative symptoms and disorders in an adult psychiatric inpatient population in Canada. Can J Psychiatry 1995;40:185–91. [PubMed]
41. Latz TT, Kramer SI, Hughes DL. Multiple personality disorder among female inpatients in a state hospital. Am J Psychiatry 1995;152:1343–8. [PubMed]
42. Lewis-Fernández R, Martínez-Taboas A, Sar V, Patel S, Boatin A. The cross-cultural assessment of dissociation. In: Wilson JP, So-Kum Tang CC, editors. , eds. Cross-cultural assessment of psychological trauma and PTSD. New York: Springer, 2007;279–317.
43. Lussier RG, Steiner J, Grey A, Hansen C. Prevalence of dissociative disorders in an acute care day hospital population. Psychiatr Serv 1997;48:244–6. [PubMed]
44. Ross CA, Anderson G, Fleisher WP, Norton GR. The frequency of multiple personality disorder among psychiatric inpatients. Am J Psychiatry 1991;148:1717–20. [PubMed]
45. Saxe GN, Van der Kolk BA, Berkowitz R, et al. Dissociative disorders in psychiatric inpatients. Am J Psychiatry 1993;150:1037–42. [PubMed]
47. Brand BL, Loewenstein RJ, Spiegel D. Dispelling myths about dissociative identity disorder treatment: an empirically based approach. Psychiatry 2014;77:169–89. [PubMed]
48. Dalenberg CJ, Brand BL, Gleaves DH, et al. Evaluation of the evidence for the trauma and fantasy models of dissociation. Psychol Bull 2012;138:550–88. [PubMed]
49. Dalenberg CJ, Brand BL, Loewenstein RJ, et al. Reality versus fantasy: reply to Lynn et al. (2014). Psychol Bull 2014;140:911–20. [PubMed]
64. Brand BL, Classen CC, McNary SW, Zaveri P. A review of dissociative disorders treatment studies. J Nerv Ment Dis 2009;197:646–54. [PubMed]
71. Modestin J, Ebner G, Junghan M, Erni T. Dissociative experiences and dissociative disorders in acute psychiatric inpatients. Compr Psychiatry 1996;37:355–61. [PubMed]
72. Tutkun H, Sar V, Yargiç LI, Ozpulat T, Yanik M, Kiziltan E. Frequency of dissociative disorders among psychiatric inpatients in a Turkish university clinic. Am J Psychiatry 1998;155:800–5. [PubMed]
76. Ross CA. Epidemiology of multiple personality disorder and dissociation. Psychiatr Clin North Am1991;14:503–17. [PubMed]
79. Tamar-Gurol D, Sar V, Karadag F, Evren C, Karagoz M. Childhood emotional abuse, dissociation, and suicidality among patients with drug dependency in Turkey. Psychiatry Clin Neurosci 2008;62:540–7.[PubMed]
161. Jepsen EKK, Langeland W, Sexton H, Heir T. Inpatient treatment for early sexually abused adults: a naturalistic 12-month follow-up study. Psychol Trauma 2014;6:142–51.
162. Foote B, Smolin Y, Neft DI, Lipschitz D. Dissociative disorders and suicidality in psychiatric outpatients. J Nerv Ment Dis 2008;196:29–36. [PubMed]
163. Mueller-Pfeiffer C, Rufibach K, Perron N, et al. Global functioning and disability in dissociative disorders. Psychiatry Res 2012;200:475–81. [PubMed]
164. Loewenstein RJ. Diagnosis, epidemiology, clinical course, treatment, and cost effectiveness of treatment for dissociative disorders and MPD: report submitted to the Clinton Administration Task Force on Health Care Financing Reform. Dissociation 1994;7:3–11.
165. Ross CA, Dua V. Psychiatric health care costs of multiple personality disorder. Am J Psychother1993;47:103–12. [PubMed]
166. Lloyd M. How investing in therapeutic services provides a clinical cost saving in the long term. 2011. At http://www.hsj.co.uk/1-september-2011/1200418.issue
167. Myrick AC, Brand BL, McNary SW, et al. An exploration of young adults’ progress in treatment for dissociative disorder. J Trauma Dissociation 2012;13:582–95. [PubMed]
168. Kluft RP. The older female patient with a complex chronic dissociative disorder. J Women Aging2007;19:119–37. [PubMed]


Comments

There are currently no comments, be the first to post one!

Post Comment

Name (required)

Email (required)

CAPTCHA image
Enter the code shown above:

Donate Now!

Partners

Health Direct

 

Head to Health

Testimonials

“Blue Knot Foundation has a key role to play in the building of community capacity in care provision to those who have experienced childhood abuse and trauma in any environment.”

NIALL MULLIGAN Manager, Lifeline Northern Rivers

“I think Blue Knot Foundation is a fantastic support organisation for people who have experienced childhood trauma/abuse, for their families/close friends and for professionals who would like to learn how to more effectively work with these people.”

Psychologist Melbourne

“It's such a beautiful thing that you are doing. Helping people to get through this.”

ANONYMOUS

“It was only last September when I discovered the Blue Knot Foundation website and I will never forget the feeling of support and empathy that I received when I finally made the first phone call to Blue Knot Helpline, which was also the first time I had ever spoken about my abuse.”

STEVEN

"At last there is some sound education and empathetic support for individuals and partners impacted by such gross boundary violations.”

TAMARA

Contact Us

Phone: 02 8920 3611
Email: admin@blueknot.org.au
PO Box 597 Milsons Point NSW 1565
Hours: Mon-Fri, 9am-5pm AEST

Blue Knot Helpline
Phone: 1300 657 380
Email: helpline@blueknot.org.au 
Hours: Mon-Sun, 9am-5pm AEST

For media comment, please contact:
Dr Cathy Kezelman
+61 425 812 197
+61 2 8920 3611
or ckezelman@blueknot.org.au


For media enquiries, please contact: 
Jackie Hanafie
+61 3 9005 7353
+61 412 652 439
 or jackie@fiftyacres.com

 

The information and resources on this site are provided for general education and as information and/or a guide only. They do not replace, and should not be used as a substitute for, counselling, therapy or other services, and should at no time be regarded or treated as professional advice of any kind. Personal needs and circumstances should always be carefully and thoroughly considered to determine the optimal approach in each individual case.