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A Comprehensive Analysis of Dissociative Identity Disorder
Few psychological disorders in the Diagnostic Statistical Manual have created the level of controversy that surrounds the disorder now known as Dissociative Identity Disorder (DID). Formerly known as Multiple Personality Disorder, this disorder has created heated debates for decades as the incidence rates for DID has risen from a relatively rare disorder with less than 100 documented cases by 1944 to now more than 20,000 documented cases in the 21st century (Wlassoff, 2017). The purpose of this paper is to introduce the definition and criteria of this disorder as found in the most recent Diagnostic Statistical Manual (DSM-5). It will also uncover the four main controversies surrounding DID and what new research, studies, or technologies have emerged to illuminate controversial topics such as it’s rising incidence rate. Because the prevalence of dissociative disorders is influenced by the surrounding cultural context; cultural factors, treatments and outcomes will also be addressed. This paper serves as a comprehensive analysis to guide the reader to better understanding this highly complex and troublesome disorder, to understand the controversies that surround it and to evaluate the current treatments and outcomes that span many different types of cultures.
Diagnostic Definition and Criteria of DID
The disorder named Multiple Personality Disorder was changed to Dissociative Identity Disorder in 1994 because of the major misconception that a person diagnosed with this disorder had multiple fully organized and coherent personalities (Psychology Today, 2019). The actual diagnosis of DID involves an individual possessing multiple identities with one being the host identity which is the most frequently encountered and carries the person’s real name and the others known as alter identities. Alters are not personalities, instead they should be understood as a reflection of the individual’s failure to integrate the various aspects of their identity, consciousness and memories (Hooley, 2016). Spiegel, a prominent theorist in this area eloquently sums it by stating, “the problem is not having more than one personality, it is having less than one.” (Spiegel, 2006, p.567).
The diagnostic criteria for this disorder found in the Diagnostic Statistical Manual is also evolving. In the DSM-IV it was required that an individual manifest two or more distinct identities that altered in some way in taking control of behavior, accompanied by an inability to recall important information that could not be explained by ordinary forgetting (Hooley, 2016). Now, in DSM-5 for the diagnosis of DID there must be a disruption of identity characterized by two or more distinct personality states as well as recurrent episodes of amnesia. Significant changes to this disorder’s criteria in the DSM-5 include that the disruption in identity can either be self-reported or observed by others and the distinct personality disruption has been expanded to include pathological possession (Hooley, 2016). These shifts in the DSM have relaxed the diagnosing criteria and could be a partial explanation to the increase in the rate of diagnosed DID cases.
Diagnostic Definition and Criteria of DID
DID typically emerges in childhood, however most patients are not diagnosed until their teens or young adulthood. Women are diagnosed with DID 3 to 9 times more than men and women tend to have a larger number of alters than men (Hooley, 2016). The gender discrepancy is argued due to females experiencing a much greater proportion of childhood abuse than males, however this argument that child abuse being a causal factor for DID is highly controversial and will be discussed further later. The number of alters within a patient has increased over time as well. One early study reported that out of 76 classic DID cases about two-thirds had only two personalities and most of the rest had three (Hooley, 2016, p.315). More recent studies estimate that about 50 percent of DID patients show over 10 identities with some claiming to have as many as a hundred (Hooley, 2016). This historical trend of increasing alter identities within an individual is argued contributed by therapists who may be encouraging the signs and symptoms of DID in highly impressionable individuals supporting a causal factor theory known as the sociocognitive theory that will also be addressed further.
As presented above, how DID develops has created four serious and interrelated controversies. When heated debates on DID among clinicians or theorists arise it usually surrounds one of the following topics: (1) Is it real or can it be faked, (2) how does it develop, (3) for those that maintain that childhood abuse is the causal factor, can these memories be proved to be real or faked, (4) If abuse did occur, did it play a casual role or was something else correlated with the abuse (Hooley, 2016). This paper will address each controversy while withholding bias to allow the reader to develop a conceptual understanding of each argument presented.
After the 1970 publication of the book, Sybil, an epidemic of DID cases was triggered (Hooley, 2016). Due to the significant rise of the prevalence of DID corresponding with the rise of media attention it receives, could lead one to question whether this disorder is actually real or is one that is faked. Historically, criminal defendants who try to use this disorder as a means of pleading insanity in their defense have been shown to be faking its symptoms. An example includes the case of the Hillside Strangler, Kenneth Bianchi. Bianchi had been accused of raping and brutally killing 10 women in Los Angeles, and even though there was a great deal of evidence against him, Bianchi continued to deny his involvement (Hooley, 2016). Some lawyers suspected that Bianchi may have had DID, he was subsequently interviewed by a psychologist who found under hypnosis that he had an alter identity named Steve. Steve confessed to the crimes, creating a bases for a plea of “not guilty by reason of insanity”, however Bianchi was later examined by an expert psychologist, Martin Orne, who suggested to Bianchi that most DID patients have more than two identities. Bianchi suddenly presented with a third identity and Orne then determined that Bianchi was faking the disorder as there was no evidence of multiple identities prior to trial and he was then convicted of the murders (Hooley, 2016). Most researchers believe that the number of DID cases that are completely fabricated is relatively rare, as there is now scientific evidence for the existence for this disorder. Researchers in Baltimore used magnetic resonance imaging to compare volumetric measurements of 15 DID patient against 23 healthy patients with no history of dissociative identity disorder or any other psychiatric disorder. In patients with DID, the hippocampal volume was 19.2% smaller and the amygdalar volume was 31.6% smaller compared to the healthy subjects.
- Hooley, Jill M., Butcher, James N., Nock, Matthew K., Mineka, Susan. Abnormal Psychology, 17th edition, (2016) Pearson
- Psychology Today. (2019, February 08). Dissociative Identity Disorder (Multiple Personality Disorder). Retrieved February 15, 2019, from https://www.psychologytoday.com/us/conditions/dissociative-identity-disorder-multiple-personality-disorder
- Wlassoff, V. (2017, November 14). The Puzzle of Multiple Personality Disorder. Retrieved February 15, 2019, from https://www.brainblogger.com/2017/11/14/the-puzzle-of-multiple-personality-disorder/
- Vermetten, E., Schmahl, C., Lindner, S., Loewenstein, R. J., & Bremner, J. D. (2006). Hippocampal and amygdalar volumes in dissociative identity disorder. The American Journal of Psychiatry, 163(4), 630-6.
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