The Conundrum of Dissociative Identity Disorder

October 12, 2016

Dissociative Identity Disorder (DID) will be diagnosed if a patient has at least two distinct, separate “alters” or personalities. Someone who has DID will act differently, like different things, have separate thoughts and interests, and basically just be completely different people with each of their alters. The patient will also experience time-lapses, where they will have periods of time they cannot recall, which is when other alters were present and in control. These symptoms are also not able to be explained by any other disorders, dementia, or substance use.

One thing that is debated to cause the later development of DID is childhood trauma- such as repeated physical or sexual abuse. It is believed that the patient will create a separate personality or become a different being to avoid having to think about or remember their experiences. It is believed that their psyche splits off to “become” someone who didn’t have to endure the abuse, as a way to forget and cope with the damaging emotional effects that severe abuse has. It is believed that this is a defense mechanism that the brain induces to protect the person from having to suffer. It is also worth mentioning that it is only a small percentage of people who are abused as children who develop DID, so some psychologists believe some people may have a certain predisposition to Dissociative Disorders.

The information about DID is controversial because it’s hard to say exactly why symptoms of DID occur; and whether or not they’re genuine. There also is a lack in studies of people who are abused and showed dissociation symptoms and lack of evidence of whether this turned into a diagnosis of DID later on. Psychologists also will sometimes use hypnosis to uncover other personalities in a patient or bring up repressed memories, and this has been thought to lead to a false diagnosis on many occasions due to the lack of concrete evidence that hypnosis can provide. There are also people believed to exist who live with DID but do not realize they do.

Some psychologists even believe that there is no accurate way to diagnose DID reliably. Drs Piper and Merksey believe that literature on DID has “logical inconsistencies… internal contradictions, and… conflicts with known facts and settled scientific principles” (Piper, 2004). They point out a flaw in logic that just because childhood trauma and DID seem to be associated, it is “fallacious” to claim that trauma causes DID. They also strongly believe that personal accounts of abuse can’t always be reliable because “memory is reconstructive (72–74) and thus quite malleable and vulnerable to suggestion.” Piper and Merksey suggest that the psychotherapy and hypnosis that a patient undergoes to bring forth a “repressed” memory, could in fact be fabricating a false memory of trauma or abuse (Piper, 2004).

There is also controversy about how DID may be treated and whether the treatment works. One group admits that treatment can be either harmful or helpful. They argue though that the benefits outweigh the risks and the “worsening of symptoms occurs among 5% to 10% of adults receiving psychotherapy in university treatment centers, employee assistance programs, clinics, and community mental health centers” this would mean that the other 90-95% of people are benefiting from the treatment. Typical treatment currently includes psychodynamic therapy in which the person with DID is offered empathy and reassurance. Therapists work to convince the patient that their dissociation is no longer needed to protect themselves, and also work on helping the patient develop effective coping skills (Brand, 2014).

The subject of DID treatment and diagnosis continues to be debated. The two papers referenced cover opposite ends of the argument and both present valid information. Piper argues that the lack of diagnosis in the past and also in other countries, is enough to question the validity of whether DID is being correctly diagnosed. Brand, however, argues that DID is actually diagnosed in “Europe, North and South America, Asia, and the Middle East, with prevalence of DID typically around 1% of the general population” (Brand, 2014), and that regardless of how small the percentage, the fact that this exists in other parts of the world warrants attention and validates that DID is very real.



REFERENCES:


Piper, A. and Merskey, H. (September 2004). The Persistence of Folly: A Critical Examination of Dissociative Identity Disorder. Part I. The Excesses of an Improbable Concept. Can J Psychiatry, Vol 49, No 9. Retrieved from: Journals.sagepub.com/doi/abs/10.1177/070674370404900904


Brand, B., Loewenstein,R., and Spiegel, D. (2014) Dispelling Myths About Dissociative
Identity Disorder Treatment: An Empirically Based Approach. Psychiatry 77(2). Retrieved from: http://web.b.ebscohost.com.ccc...