Research of Whether Dissociative Identity Disorder is a Real Disorder

Introduction

Dissociative identity disorder is a serve form of dissociation that causes one to lack a sense of connection with one’s feelings, sense of identity and one’s own individual’s thoughts. DID has been officially recognized as a mental disorder since its inclusion in the 1980 release of the Diagnostic and Statistical Manual of Mental Disorders (DSM-III). It can create one or more alternative personalities that function without the person’s awareness and usual personality.

The dissociative aspect is thought to be a coping mechanism, the person literally shuts off or dissociates himself from a situation or experience that's too violent, traumatic, or painful to assimilate with his conscious self. With dissociative identity disorder, there are also highly distinct memory variations, which fluctuate with the person's split personality. The 'alters' or different identities have their own age, sex, or race. Sometimes the alters are imaginary people; sometimes they are animals. However, even through the number of decades this disorder has been researched, a number of misconceptions and myths about the disorder remain, compromising both patient care and research.

DID is amazingly rare and there is not definite way to be diagnosed within an individual which causes many to speculate the legitimacy of this disorder. Even through people’s uncertainties, this disorder has enough research that can back up scientifically and empirically that this is indeed a true disorder.

A bit of history

Within the year 1584, the first case of what is now known in society to be Dissociative Identity Disorder was ever documented. During this time however, many believed it did not deal with traumatic experiences or a mental disorder but believed it dealt with the devil or hell. A woman by the name of Jeanne Fery was said to have experienced and have multiple alters, each having their own name as well as identity and features that differentiated them. Even though at first for many it was difficult to comprehend why this woman was behaving in this manor.

As years went on, it was shown that different individuals were having these same symptoms however it was rather difficult to identify what the cause was for it and what it truly meant for an individual, was this just a mental abnormality, was this people faking it or was this truly a disorder. As time went on there was a correlation that began to be demonstrated even with Jeanne Ferty, all these individuals went through traumatic experiences or childhoods that they have not been able to fully process or even accept what occurred. People for some time however began associating these symptoms with hysteria.

Hysteria was seen as primarily dissociative in nature and could involve disturbances of memory, consciousness, affect, identity, and body functions), the same symptoms today associated with dissociative disorders and particularly with dissociative identity disorder. The first person to be officially diagnosed with multiple personality disorder instead of double personality disorder as had eventually come into use in France) was Louis Auguste Vivet in 1882. Louis was physically abused and neglected as a child and had frequent “attacks of hysteria.” By 1888, he had been recorded as having 10 personality states, each of which were different in character, memory, and somatic symptoms. The symptoms when the disease was first discovered were contortions, convulsions, fainting, and impaired consciousness.

Within the 1970’s, Dissociative Identity disorder began to become more commonly looked into and analyzed due to the publication of the book Sybil. This caused a substantial increase in the reports of DID and many individuals were admitting themselves based on feeling they have this type of disorder. Additionally, as more and more cases of DID were reported, more and more alternate personalities (alters) were reported in each case.

The majority of cases noted by 1944 manifested with only two personalities, while there was an average of 15.7 alters noted in cases reported in 1997. This caused skeptics to begin questioning the legitimacy of this disorder and whether individuals were genuinely telling the truth. However, with DID becoming more known it created more need for research and studies to be conducted which led to a sufficient amount of information that concluded that these symptoms were a true disorder and eventually led it to be added within the Diagnostic and Statistical Manual of Mental Disorders which is listed as three types of dissociative disorders which is dissociative identity disorder, dissociative amnesia and depersonalization disorder.

Topic analysis

For someone to be diagnosed with Dissociative Identity Disorder they have to have certain symptoms and demonstrate as well certain characteristics. One usually has general memory problems, a sense of losing time, feelings of detachment, somatoform symptoms as well as speech insertion. The individual most also exhibit two or more personalities or alters and may have temporary loss of well-rehearsed knowledge or skills and disconcerting experiences of self-alteration. All these symptoms are key aspects when one is being diagnosed for Dissociative Identity Disorder.

Doctors diagnose dissociative disorders based on a review of symptoms and personal history. A doctor may perform tests to rule out physical conditions that can cause symptoms such as memory loss and a sense of unreality like brain lesions or sleep deprivation). The symptoms demonstrated are pretty specific due to the fact that there is a difficulty to be able to diagnose this type of disorder since one cannot just do a CT or medical scans, truly the only way to be able to really diagnose an individual is to go through an extensive amount of questions and analyze the symptoms through to confirm that someone does have Dissociative Identity Disorder.

Like it was mentioned previously, these symptoms and characteristics arise after traumatic experiences such as an accident or disaster like one getting raped or being physically or mentally abused as a child. Dissociation with one’s traumatic experiences can help a person tolerate what might otherwise be too difficult to bear.

In situations like these, a person may dissociate the memory of the place, circumstances or feelings about of the overwhelming event, mentally escaping from the pain and fear. This may make it difficult to later remember the details of the experience, as reported by many disaster and accident survivors. DID can be overlooked due to both this poly-symptomatic profile and patients’ tendency to be ashamed and avoidant about revealing their dissociative symptoms and history of childhood trauma.

Throughout the decades of DID being researched and evaluated, there has been a certain amount of controversy related to whether or not this truly is a disorder. There are sides that are able to support the claim that these symptoms and aspects are more than sufficient enough evidence to support that it is a real disorder while others within the world may think these individuals are faking it or there is another underlining cause for it. Some experts believe that it is really an 'offshoot' phenomenon of another psychiatric problem, such as borderline personality disorder, or the product of profound difficulties in coping abilities or stresses related to how people form trusting emotional relationships with others. From how this disorder is diagnosed to the research conducted on DID, it has always been a controversial topic of debate.

Even though the diagnosis of DID is rather controversial, there has been a substantial amount of evidence done over the years that have demonstrated why this is actually a disease and not an extension of one that has already been diagnosed. One study went into detail about the idea that DID is based on fantasy and the social aspects around a person which they feel is the determining factor that causes one to think they have an actual disorder.

Within this study high fantasy prone and low fantasy prone controls were studied in two different types of identity states which were neutral and trauma-related in an autobiographical memory imagery. There were twenty- nine subjects that were being examined within this experiment, 11 patients with DID, 10 high fantasy prone DID simulating controls, and 8 low fantasy prone DID simulating controls. Within the results it was shown that the identity states in DID were not convincingly enacted by Dissociative identity disorder simulating controls.

Differences regarding regional cerebral blood flow and psychophysiological responses for different types of identity states in patients with DID were upheld after controlling for DID simulation. The findings are at odds with the idea that differences among different types of dissociative identity states in DID can be explained by high fantasy proneness, motivated role-enactment, and suggestion. They indicate that DID does not have a sociocultural origin and was not influenced by the people around them.

Another study went into detail about the controversial topic that many feeling that DID is primarily diagnosed in North American by individuals that are considered experts within DID and that these doctors are over diagnosing these patients. A study was conducted in this in three different ways, by examining the countries in which prevalence studies of DID have been conducted; by inspecting the countries from which DID participants were recruited in an international treatment-outcome study of DID; and by conducting a systematic search of published research to determine the countries where DID has been most studied.

The results show that DID is found in prevalence studies around the world whenever researchers conduct systematic assessments using validated interviews. Second, in addition to the prevalence studies, a recent prospective study assessed the treatment outcome of two hundred and two DID patients from around the world. The participants lived in places from Australia to Taiwan and even the United States. Participants came from every continent except Antarctica. Over this nine-year period, 70 studies included DID patients. Significantly, these studies were conducted by authors from 48 institutions in 16 countries.

Another largely debatable argument within this disorder is that many feel as if DID is within the same controversy of Borderline Personality Disorder and DID itself is just an extension of it, one of the difficulties in differentiating BPD from DID has been the poor definition of the dissociation criterion of BPD in the DSM’s various editions. On the surface, BPD and DID appear to have similar psychological profiles and symptoms.

Abrupt mood swings, identity disturbance, impulsive risk-taking behaviors, self-harm, and suicide attempts are common in both disorders. Indeed, early comparative studies found few differences on clinical comorbidity, history, or psychometric testing using the Minnesota Multiphasic Personality Inventory and the Millon Clinical Multiaxial Inventory. However, recent clinical observational studies, as well as systematic studies using structured interview data, have distinguished DID through the clinical symptoms and psychosocial variables that distinguish DID from BPD: It has been shown that individuals with BPD show vacillating, less modulated emotions that shift according to external precipitants.

In addition, individuals with BPD can generally recall their actions across different emotions and do not feel that those actions are alien or so uncharacteristic as to be disavowed. By contrast, individuals with DID have amnesia for some of their experiences while they are in dissociated personality states, and they also experience a marked discontinuity in their sense of self or sense of agency. With regard to the frequent comorbidity between DID and BPD, studies assessing for both disorders have found that approximately 25% of BPD patients endorse symptoms suggesting possible dissociated personality states.

A national random sample of experienced U.S. clinicians found that 11% of patients treated in the community for BPD met criteria for comorbid DID,84 and structured interview studies have found that 31%–73% of DID subjects meet criteria for comorbid BPD. This demonstrated that about 30% or more of patients with DID do not meet full diagnostic criteria for BPD.

As we have shown, current research indicates that while approximately 1% of the general population suffers from DID, the disorder remains undertreated and under recognized. The average DID patient spends years in the mental health system before being correctly diagnosed. 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. 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.

The misconception that DID is a rare or iatrogenic disorder may lead to the conclusion that this disorder is one on which resources should not be expended (whereas we have shown the opposite to be the case). In combination, these myths may discourage scholars from pursuing research about DID and also inhibit funding for such research, which exacerbates, in turn, the lack of understanding about, and the currently inadequate clinical services for, DID.

Even with the research that supports the claims that Dissociative Identity Disorder is a real disorder, there are till this day sceptics that believe that there is not enough evidence to back it up. Some people that the therapists themselves may notice some symptoms or features and automatically go straight to DID, this is called the iatrogenic model (Nakdimen, 2006). F. This model goes into detail about the idea that individuals are being overly diagnosed due to the lack of knowledge or research that has been done. Some believe that therapists reinforce patients when they display certain behaviors and encourage patients who do not have DID to begin to believe they have the disorder.

They may be more inclined to diagnose this disorder when they think the clients are fantasy-prone and are highly suggestible by nature (Ross, 2009). They tell them what the disorder it and what the symptoms are and the clients then begin to act as if they have DID. the danger for the consumer is that if a therapist unquestioningly buys into the label, the therapist will be likely to find or manufacture evidence that supports the diagnosis.

. Even more alarming is that some clinicians actually encourage behaviors that seem consistent with the label, which increases the likelihood that the client will act more like the label and begin to 'fit' into this diagnostic category.

Skeptics have also risen from the movie Sybil, some individuals see it as an supporter of this disorder however others have seen it as a true testament of falsifications that have been created. Sybil went into detail about individuals with DID and the experiences and symptom they faced which for many made them feel like they obtained a better understanding.

However, throughout the years it has been said to be a complete hoax and fraud from three women that were just trying to make money and a name for themselves (Ross, 2009). It had been confirmed that the story was actually fabricated and made people question. Is this disorder real or are individuals just seeing this “disorder” as unique, different and memorizing that people fantasy and medically wish it to be true?

Conclusion

Even through the years of research and debate about whether or not DID is a true disorder or not will be a conversation for years to come. DID has evidence to back up the claims that it is a real disorder from the DSM to the symptoms and treatments that pertain to the positive assistance in helping relieve the symptoms of this disorder. However, there is also information that demonstrates that research is rather limited still and more needs to be conducted which causes a lot of the skeptics in society. It has been seen in the past for people to diagnose individuals with this disorder when they truly do not have it due to just wanting to obtain an increase of fame or be known as having a client with this disorder which in society is not so common in today’s day and age.

In reality, there is still a need for a lot of research to be done and with the limited number of individuals who actually do have this disorder it is rather difficult to be able to say with 100% certainty at times. However, there is still a good amount of information and cases that can support the claim enough that DID is truly a disorder and one that will always be difficult to understand.

Citations

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