Is Dissociative Identity Disorder Real?

We would like to thank you for considering our group to be a part of your preliminary research team for the article on Dissociative Identity Disorder. The annotated bibliography provided by my team contains an assortment of sources including journal articles, websites, and videos for reference. We as a team have studied Dissociative Identity Disorder and its controversy, we have also compiled many studies, treatments, and case studies that are key in comprehending the fundamental concepts of dissociative identity disorder. We hope these references, and the content that we have complied will help you in your writing process!

Regards,
Athena, Sharon, Nawal and Darshika

Dissociative Identity Disorder Timeline

The photo below is a timeline that depicts some of the key milestones, developments, statistics and cases of Dissociative Identity Disorder (DID). The pictures on the upper half of the time line are as follows: a child holding multiple balloons with different personalities, signifying the development of multiple personalities from childhood trauma; A picture of an advertisement of “The Three Faces of Eve”, a novel and movie; an advertisement of the movie Sybil. “The Three faces of Eve” and “Sybil” were two very influential novels that later became movies, changing the publics perception of DID and contributing to the increasing the diagnoses of DID. On the bottom row the first photo is a key concept depicted in the 20th century that DID was only a case of two personalities or “split brain”. The next photo is one of Alfred Binet a very influential psychologist but often not credited for his work in the field of dissociation. The last photo is the different DSM covers that have been published.
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What is Dissociative Identity Disorder?

Murray, J. B. (1994). Dimensions of Multiple Personality Disorder. The Journal of Genetic Pyschology, 237-238.

This journal article shows the research that has been done on the Dissociative Identity Disorder. Before further indulging into the study, there was a brief introduction provided which clearly explains what this disorder is. This article is relevant as it shows how this disorder can be diagnosed.

The Dissociative Identity Disorder is a mental disorder, where there is an existence of at least two or more distinct personalities within a person. These alter identities control a person’s behaviour which results in memory impairment of very important personal information that is not explicable by ordinary forgetfulness. On average there are about 2 to 4 personalities present. This disorder was formerly known as the Multiple Personality Disorder. The Dissociative Identity Disorder is one of the most controversial psychiatric disorders as there is no clear diagnosis or medication available. This disorder could be an effect of a severe past trauma which may have occurred in early childhood, some examples being; physical, sexual or emotional abuse. It is a severe form of dissociation, which acts as a coping mechanism from past childhood abuse, where you view yourself as the victim of experiences that are too violent, traumatic or painful to comprehend with.

Symptoms

Dissociative Identity Disorder (Multiple Personality Disorder). (2014, 11 24). Retrieved from Pyschology Today: https://www.psychologytoday.com/conditions/dissociative-identity-disorder-multiple-personality-disorder

Psychology Today is an excellent and creditable website which talks about current psychological issues. There is a list of symptoms associated to the Dissociative Identity Disorder on their website. This is a useful source as symptoms play a key role in diagnosing this disorder, and it is necessary for people to be aware of the potential signs.

• The presence of two or more split personalities
• These indemnities take control over a person’s behavior
• May possess a separate name
• Memory gaps (inability to recall personal information, people, places, or events)
• Manner of talking
• Dress differently
• The transitions between personalities are triggered by psychosocial stress
• Aggressive behavior
• Suicidal attempts

You may experience:
• Depression
• Mood swings
• Insomnia
• Sleep walking
• Panic attacks
• anxiety
• Headaches
• Time loss
• Difficulty breathing
• Extreme fatigue
• Visual or auditory hallucinations

Somatic Symptoms you may experience during a personality switch:
• Dyspnea
• Palpitations
• Sensations of choking or smothering
• Paraesthesias
• Faintness
• Trembling
• Auditory hallucinations that command self-destructive or violent acts
• Auditory hallucinations of crying, screaming or laughter
• Patients report seeing themselves as different people in the mirror (in relation to hair, eyes, skin and/ or gender)
• Hallucinations of alter personalities as people existing outside of their bodies
• Suicidal behaviour

Diagnosis

There are no tests that can be done in order to diagnose this disorder. Practitioners may conduct mental health assessments or interviews looking for the presence of any signs or symptoms.

Putnam, F. W. (1989). Diagnosis and Treatment of Multiple Personality Disorder. New York: The Guilford Press.

This book talks about the criteria necessary to make a diagnosis and the certain type of treatment that reduces the effects of this disorder. This book is extremely useful as there is no fundamental cure for this disorder; however from what is retrieved from this book, early signs can be detected.

The first step in making a diagnosis is to determine if your patient has had any dissociative experiences. Patients usually have great difficulty providing their life history in a clear and chronological manner. Questioning is a method used to confirm if there are any signs of amnesia. Putnam states that he asks his patients questions such as, “whether they have ever found themselves dressed in clothing that they did not remember putting on. I may even ask such people to close their eyes and tell me what they are wearing” (1989, p. 75). Most people will be able to tell what they are wearing unless an alternate personality made that conscious decision.

There are also physical signs that show the switching between personalities.

AREA: CHARACTERISTICS:
Appearance Dressing style, grooming, general appearance, and mannerisms may change dramatically from session to session. Marked changes in facial appearance, expression, posture and mannerisms occur within a single session. Handedness and habits such as smoking may change as well.
Speech Changes in rate, pitch, accent, loudness, vocabulary and the use of idiosyncratic expressions or profanity may occur.
Motor Processes Rapid blinking, eye fluttering, marked eye rolls, twitches, startle reactions, or shudders and facial grimaces often accompany the switching of alter personalities.
Thought Processes May appear non sequential and illogical sometimes. Loose associations, along with losing their train of thought.
Hallucinations Auditory and/or Visual Hallucinations. Voices commanding or arguing with the patient. These voices are frequently heard inside the patient’s head.
Intellectual Functioning Short-term memory, orientation, calculations and general knowledge. Long term memory is unlikely affected.
Judgement Rapid fluctuations in the appropriateness of behaviour and/or judgment. These shifts are common during different age dimensions. For example shifts between adult to childlike behaviour.
Insight The personality present for treatment is 80% of the time not aware of the existence of the alternate personalities.

Jerome, L. (1992). Diagnostic Criteria for Multiple Personality Disorder. The American Journal of Psychiatry, 576-577.

Other forms in which a Diagnosis for this disorder can be made, is based on either confirming the symptoms or by asking certain questions in order to determine if there are any potential signs of amnesia. Frequent questions asked are:

1) Do people ever say things that you don’t remember doing?
2) Do you ever find yourself in places but cannot recall how you got there?
3) Do you have difficulty remembering where you were and what you were doing during the preceding hour?
4) -If the patient answers yes to any of these questions, then amnesia can be recognized. When amnesia occurs there are often memory gaps and a great difficulty in recalling everyday events and other personal information.

Brenner, I. (1996). The characterological basis of multiple personality . American Journal of Psychotherapy, 154-166.

Further diagnostic criteria includes identifying if there is some sort of a presence of two or more distinct personalities, that are repeatedly taking over a person’s behaviour. The person will also begin to face trouble while functioning in their daily lives.

Putnam, F. W. (1989). Diagnosis and Treatment of Multiple Personality Disorder. New York: The Guilford Press, 118-123.

Putnam discusses that other than symptoms, there are a number of indicators that show the switch between personalities, which can be used to help with the process of diagnosis.

The most apparent indicators are physical changes. Facial changes are easy to note as most transformations are obvious in the eyes or mouth area. Transformations include jaw shifts which can change an underbite to an overbite, wrinkles, creases in the face are compared to normal expression changes that occur. There may be changes in body posture or body language. For example an infant may personality may crawl up into a fetal like position or huddle in corners. In the case of motor abilities, the alter personalities’ may suffer from psychogenic disabilities, blindness, deafness or mutism. Speech changes occur when a child personality may use baby talk or childlike grammar, or other speech defects such as stuttering.
Other noted indicators are psychological changes between the switches. Suddenly, anger may come out of the blue, sudden laughter or tears that are out of context. After these sudden bursts, the primary personality may resume from where they had left off, without any recognition that something unusual had occurred.

Childlike personalities that exist are easier to recognize, as there is a sudden change in a person’s level of maturity. In some cases patients, learn how to disguise or over up the initiation of a switch. For example women tend to turn their faces away or shield their faces with their hands.

This book serves as a relevant source, since sometimes not all symptoms are obvious, as the alters learn to disguise them. Hence this book could be used as a tool to notice other signs.

Treatment

Murray, J. B. (1994). Dimensions of Multiple Personality Disorder. The Journal of Genetic Pyschology, 240-241.

Murray looks at what can be done to cure people from this disease. There is no known cure for this disorder, hence the only option being long term treatment. The main method of treatment used is therapy. The primary goal of the therapist is to recover any memory gaps and recognize the disorder. Different approaches used are psychodynamic or hypnotherapy. The symptoms are a hidden phenomenon as there is a denial or continued secrecy which can become an obstacle in the progress of the treatment. This information is relevant as it is important for the general public to be aware that there is no treatment or surgery that can be done to get rid of this disorder, unlike other illnesses. He covers the primary goal behind therapy and what must be done in order to achieve it. It’s useful for people to know what sort of techniques are used in therapy, as if they need any therapy sessions, they would feel more comfortable attending. Confidence is necessary, which will then help build trust and good relationship between you and the therapist. Generally, then progress can be made faster.

Putnam, F. W. (1989). Diagnosis and Treatment of Multiple Personality Disorder. New York: The Guilford Press, 138-141, 167-169.

For the purposes of treatment, the patient may need to be hospitalized, depending on the severity of the disorder. In order for therapy to work effectively, the therapist needs to develop trust with the patient. There are a few stages to treatment, they are;

1) Making a diagnosis
2) Initial Interventions; begin working with the patient, the primary task being to meet the alter personalities
3) Initial Stabilizations; Contracting with the alter personalities and the patient, in order to control what used to be uncontrollable behaviours.
4) Acceptance of Diagnosis
5) Develop communication and cooperation
6) Metabolism of the Trauma; now the therapist must become more aggressive in discovering and uncovering past secrets
7) Resolution & Integration
8) Development of post resolution coping skills

The effectiveness of therapy depends highly on the frequency of the sessions. The recommended average is 2 to 3 times a week. The length of these sessions is also an important feature, but note that most of these sessions do not end on time. The sessions are set up to be at least one hour long, so that there is enough time given for the alter personalities to speak up. The availability of the therapist outside of sessions is highly beneficial. The therapists should be available for emergency work, and may receive several phone class from the alters. For more severe cases, special or extended sessions must be set up.

A common technique used in therapy is the use of video tapes, in order to have a record of the alter personalities.

This section of the book refers to all the possible treatments used for the dissociative identity disorder. Many steps that are made in relation to a diagnosis are provided, therefore anyone without a medical background can also predict whether someone has this disorder or not. Other advice is also given related to the frequency of and what should be covered in weekly therapy sessions. This information is relevant as a diagnosis could be made much faster as well as understand how helpful therapy is.

Medication

Putnam, F. W. (1989). Diagnosis and Treatment of Multiple Personality Disorder. New York: The Guilford Press, 256-259.

Putnam states extremely useful and important information in this chapter of his book. In present day, the society is dependent on medications as they feel they present the cure for an illness or disease. However there are no established medications that could be taken for this disorder, hence therapy is used. However common symptoms such as for anxiety and depression, medications are used to keep them under control. Anti-depressant or anti-anxiety drugs are used in order to reduce the patients distress linked with the disorder. The medication also calms the patient during treatment and reduces anxiety and nightmares. Sleeping pills help control any type of sleep disturbances like sleep walking or insomnia. Analgesic medications are prescribed for pain syndromes present. This source provides other alternatives to medication that the society should be aware of. The forms of medications mentioned above are methods which must be used in order to keep this disorder under control in addition to taking care of your health.

Facilities

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There is a facility available in the GTA (Greater Toronto Area), Canada. The William Osler Health System offers Mental Health Services for Children and Adolescents. There are two children's mental health inpatient units at the Brampton Civic Hospital.

For more information, you may call 905-494-2120 or visit the William Osler Health System Website at:
http://www.williamoslerhs.ca/

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Brampton Civic Hospital
website: http://www.williamoslerhs.ca/about-osler/osler%27s-facilities/brampton-civic-hospital

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Depending on how severe your disorder may be, some people are willing to travel outside of the country for treatment. One great facility is the Psychological Care & Healing Treatment Centre based in Los Angles California. The intake team is available 24 hours a day to respond to emergency calls. The offer much different treatment programs to match what you are comfortable with, and have an excellent program designed especially for the Dissociative Identity Disorder. The Executive and Clinical Director of the Centre, Dr. Jeff Ball has been treating patients associated with Dissociative Disorders for over 25 years. Dr. Ball has a very experienced and qualified team to help cure the trauma or disassociation.
For more information, you may call 888-724-0040 or visit their website at:
http://www.pchtreatment.com/

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The Grand River Hospital in Waterloo offers its patients a Mental Health & Addictions Program.

For more information, you may call 519-744-1813 or visit http://www.grhosp.on.ca/home

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For additional information, you may visit Ontario’s Ministry of Health website at http://www.health.gov.on.ca/en/

All of the facilities listed above are great resources that are encouraged to be used. The locations are very convenient and the information for each is presented on this page. The regions for each location are listed, along with its phone number and website, making it easier to contact.

Patients

Marilyn Monroe:

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Famous People with Dissociative Identity Disorder. (2013, 12 11). Retrieved from Health Research Funding: http://healthresearchfunding.org/famous-people-dissociative-identity-disorder/

Monroe was an American model, actress and singer. Her maternal grandparents and mother also suffered from the same condition; hence she also grew up with this disorder. Monroe grew up in a foster home, which also affected her development as a child.

Shirley Ardell Mason:

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Thompson, G. (2015). The Hidden Paintings of Shirley A. Mason… Sybil. Retrieved from Hidden Paintings: http://www.hiddenpaintings.com/

One of the most famous cases on the dissociative identity disorder is based on Shirley Ardell Mason. She was a psychiatric patient diagnosed with dissociative identity disorder. A fictionalized book was published based on her disorder called Sybil in the year 1973. Later in 1976 and 2007 two films with the same name were released. As a child she had been abused by her mother, the trauma then caused over 16 different personalities to develop within her.

Herschel Junior Walker:

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Herschel Walker. (2011, 03 01). Retrieved from Academy of Achievement: http://www.achievement.org/autodoc/page/wal0bio-1

Herschel Junior Walker is a professional football player and a mixed marital artist. He revealed that he has dissociative identity disorder in 2008. He recognized that the root of this problem was due to his childhood experience of bullying and isolation, and immediately got professional treatment. The reason why Walker made his disorder public was to encourage others to also find help if they required it as well as to advance the understanding of this topic.

In the video below, Walker’s ex-wife Cindy, talks about his disorder. She noticed things like voice changes, and had even meet quite a few of his alter personalities. A lot of the things that Cindy remembers, Herschel does not. His therapist talks about the nature of the alters, like how violent and dangerous they were. Walker’s wife shares the experiences she had living with Walker during this time and coming in contact with the different alters and how this all affected their lives.

XanderHarris2012. (2015, April 2). DID- Dissociative Identity Disorder 2of2. Retrieved from: https://www.youtube.com/watch?v=6XlKOC-WnZo

Tracy:

The video below is from an episode of Dr. Phil. Tracy claims to have five different personalities inside of her. The 5 alters are captured in this video, along with what effect they have on her daily life.

Wright, Holly. (2015, April 7). Dr. Phil – Multiple Personality Disorder. Retrieved from: https://www.youtube.com/watch?v=-fWTBh4fyUM

Categories of Dissociative Identity Disorder

Putnam, F.W. (1989). Diagnosis and Treatment of Multiple Personality Disorder. New York: The Guilford Press, 27-33.

The Host Personality:

All individuals with DID have at least one alter who serves as the “host.” The host has been defined as “the one who has executive control of the body the greatest percentage of time during given time” (Kluft, 1984, p. 23). Frequently this is the personality that presents for treatment and the one who becomes identified as the “patient” prior to the diagnosis of DID. The typical host personality is depressed, anxious, anhedonic, rigid, frigid, compulsively good, conscience-stricken, and masochistic, and suffers from a variety of somatic symptoms, particularly headaches (Kluft, 1984).

Therapists who have been exposed to a number of cases of DID, however, quickly come to recognize that certain broad categories of alter personalities can be found in common across most patients. Although, the overriding common denominators that allow characterization of alter personality types are the functions that the personalities serve and the affects and memories that they carry. Now, each person with DID is unique, but some principles of organization are typical. There are many other categories in which include child personalities, demons and spirits, and etc.

Other related Disorders

Gluck, S. (2008). Types of Dissociative Disorders - HealthyPlace. Retrieved April 2, 2015, from http://www.healthyplace.com/abuse/dissociative-identity-disorder/types-of-dissociative-disorders/.

There are 4 major types of Dissociative Disorders:

1) Dissociative Amnesia
2) Dissociative Identity Disorder
3) Dissociative Fugue
4) Depersonalization Disorder

Each of the four major dissociative disorders is characterized by a distinct mode of dissociation. Dissociative disorder symptoms may include:

Dissociative Amnesia: Memory loss that's more extensive than normal forgetfulness and can't be explained by a physical or neurological condition is the hallmark of this condition. Sudden-onset amnesia following a traumatic event, such as a car accident, happens infrequently. More commonly, conscious recall of traumatic periods, events or people in your life — especially from childhood — is simply absent from your memory.
Dissociative identity disorder. This condition, formerly known as multiple personality disorder, is characterized by "switching" to alternate identities when you're under stress. In dissociative identity disorder, you may feel the presence of one or more other people talking or living inside your head. Each of these identities may have their own name, personal history and characteristics, including marked differences in manner, voice, gender and even such physical qualities as the need for corrective eyewear. There often is considerable variation in each alternate personality's familiarity with the others. People with dissociative identity disorder typically also have dissociative amnesia.

Dissociative Fugue: People with this condition dissociate by putting real distance between themselves and their identity. For example, you may abruptly leave home or work and travel away, forgetting who you are and possibly adopting a new identity in a new location. People experiencing dissociative fugue typically retain all their faculties and may be very capable of blending in wherever they end up. A fugue episode may last only a few hours or, rarely, as long as many months. Dissociative fugue typically ends as abruptly as it begins. When it lifts, you may feel intensely disoriented, depressed and angry, with no recollection of what happened during the fugue or how you arrived in such unfamiliar circumstances.

Depersonalization Disorder: This disorder is characterized by a sudden sense of being outside yourself, observing your actions from a distance as though watching a movie. It may be accompanied by a perceived distortion of the size and shape of your body or of other people and objects around you. Time may seem to slow down, and the world may seem unreal. Symptoms may last only a few moments or may wax and wane over many years.

Dissociative Disorder survivors generally spend years living with misdiagnoses, consequently floundering within the mental health system. They change from therapist to therapist and from medication to medication, getting treatment for symptoms but making little or no actual progress.

This section states that research that, on average, people that have dissociative disorders have spent seven years in the mental health system prior to accurate diagnosis. This is common, because the list of symptoms that cause a person with a dissociative disorder to seek treatment is very similar to those of many other psychiatric diagnoses. In fact, many people who are diagnosed with dissociative disorders also have secondary diagnoses of depression, anxiety, or panic disorders. It is important to make sure that one who may be have symptoms of this disorder or any disorder of that matter it is relevant to go get some assistance and understand what the situation is and how to go about dealing with it.

Scientific reason why it is caused

Science based case studies are very important in understanding exactly what neurologically is happening with someone who has DID. Also, when scientific information regarding DID is presented it also aids in the development of treatment and the public’s acceptance of the disorder being “real”.

Vermetten, E., Schmahl, C., Lindner, S., Loewenstein, R., & Bremner, J. (2006). Hippocampal And Amygdalar Volumes In Dissociative Identity Disorder. American Journal of Psychiatry, 630-636.

The hippocampus and amygdala are two very important parts of the brain in relation to Dissociative Identity Disorder. The amygdala is where the specific emotion is identified to see if the stimulus is harmful or not. The hippocampus is where the memory is stored, it also plays a critical role in learning, memory, and stress regulation. The strong relation between stimuli and particular memories links the amygdala and the hippocampus. This can essentially mean that a situation relating to a traumatic event can provoke anxiety.

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This is a photo of the Amygdala and Hippocampus

Phelps, E. (2004). Human Emotion And Memory: Interactions Of The Amygdala And Hippocampal Complex. Current Opinion in Neurobiology, 198-202.

This journal article is a study published in the American Journal of Psychiatry. It shows that people who live with DID have smaller hippocampal and amygdalar volumes than healthy patients. The percentage of Hippocampal volume was 19.2% smaller and amygdalar volume was 31.6% smaller. In both cases of animal and human testing, studies show that stress in the early stages of life change the growth and structure of the hippocampus, impacting the subjects’ memory and stress regulation. MRI imaging has also revealed adults with PTSD, or those who have endured childhood physical or sexual abuse will have a smaller hippocampal size.

Historical

Dell, P. (2009). Dissociation and the dissociative disorders: DSM-V and beyond (pp. 3-21). New York: Routledge.

This journal is an excellent example of a detailed account of historical events leading to the present day. It mentions many key contributors to psychology as well as psychiatry. It also references to many case studies. Although this may be one of the more lengthy journals written on DID it provides the reader with a time line of events and co-relations between ideas and theories throughout time. By being able to collect historical information regarding DID it provides us with the ability to understand, better treat and diagnose patients with DID. This disorder has often been misunderstood as well as misdiagnosed as a different disorder, and historical accounts help facilitate a psychiatrists to appropriately diagnose a patient as well as understand the prevalence of this disorder.

Often through history demonic possessions or witchcraft was reported and documented, but now many experts suspect that some of these cases could very well have been cases of Dissociative Identity Disorder (DID).

1791- Eberhardt Gmelin was the first to publish a case of “exchanged personality”. This is the first detailed documented account of DID. The case was involving a 20-year-old woman who would go into the state of a French-speaking woman. The woman was unable to recall anything about the French lady but the French alter had knowledge of there being another lady.

1840- Estelle's case, a monograph by Despine, involved an 11-year-old girl from Switzerland who had paralysis and extreme back pain, who she developed a personality who could walk and play and had negative feelings towards her mother. Estelle’s two personalities were very clearly separate and distinct. Despine believed and reported that she was able to cure the girl through treatments that are still used and recognized as valid today.

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The photo above is a portrait of Antoine Despine

1855- “Gros Jean” also known as Paul Tascher, posed the theory that specific nervous disorders, specifically: possession states, magnetism, and automatic writing, involved a division of personality. He argued that these phenomena are due to the existence of another personality that is capable of “romantic fabrications and digressions”.

1888- Jules Janet used the model of “double personality” to explain DID at the time. The problem was this did not provide the explanation for there being more than two personalities. Janet proposed that we all have two personalities within us there is the conscious and unconscious. In a patient with hysterics, the two are not harmonious with each other and the first personality is incomplete.

1891- Binet supposed that there could be more than two personalities after reviewing case studies regarding DID.

1893- Freud believed that childhood trauma and abuse was a root cause of hysteria. He also thought dissociation was the ego’s defense against the manifestation of hysterical paralysis.

1956- The fictional novel that was written as a documentary and titled “ The Three Faces of Eve” is about a woman who has three personalities. This was the first multiple Personality book to reach out to the public’s imagination.

1957- “Eve”, the movie, staring Joanne Woodward was a spin off of the book “ The Three Faces Of Eve”. The movie convinced many that multiple personality disorder is real and common.

1968- Multiple Personality Disorder was defined in the American Psychiatric Association’s Diagnostics and Statistics Manual (DSM II) of mental disorders.

1973- The book Sybil was on shelves, it was a documentary describing a women’s experience with Multiple Personality Disorder MPD therapy. The main character in the book was possessed by 16 personalities.

1976- Sybil was broadcasted as a movie this was a turning point for the public in the acceptance and perception of DID.

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This is an image of a scene from the movie Sybil

1980- The introduction to Recovery Memory Therapy. This was a way in which therapists would recover images of childhood abuse or traumatic events. Therapists believed these were the cause of DID.

1994- The American Psychiatric Association renamed MPD as Dissociative Identity disorder in the DSM IV

1995- 40,000 cases of DID were diagnosed between 1985 and 1995

Present day- Approximately 1-3% of the general population is diagnosed with DID

Influences

Putman, F. W. (1989). Diagnosis and Treatment of Multiple Personality Disorder. New York: The Guilford Press, 107-114.

There are several factors that play a role in influencing the form of traumatically induced dissociative reaction (Putnam, 1985).

Age

The age of the individual at the time of the trauma, when coupled with certain other factors, may play a crucial role in determining the form of dissociative reaction (Putnam, 1985). The demographic data on victims of dissociative disorders are scanty, but indicate that some types of dissociative reactions are more likely to be seen in specific age groups. There is also some evidence that comes from data indicating that the age or developmental stage during which sustained trauma occurs plays an important role in determining whether or not an individual develops DID. In addition, data from many types of studies show that a history of childhood trauma is also a strong correlate of adult hypnotic susceptibility (Putnam, 1985).

Gender

The role of gender in terms of dissociative reactions is extremely difficult to assess. Many of the published studies and case collections were subject to forms of sampling biases that may have overrepresented either sex. Although, the published case collections of dissociative identity disorder patients have all exhibited a significantly higher incidence of females. Female to male ratios were as high as 8:1 or 9:1 yet some other therapists reported much lower rates of ratios of between 4:1 and 2:1. Female DID patients, with their tendency to direct their violence toward themselves in the form of suicide-attempts and gestures or self-mutilation, are more likely to be seen in the mental health system; males, with their tendency toward more externally directed violence, are more likely to be encountered in the criminal justice system. The single survey of a criminal population published to date indicated a surprisingly high incidence of DID among rapists and sex offenders.

This section looks at the influences of dissociative identity disorder. I believe this is relevant information because its important to understand that age and gender may be in fact influence the form of DID. Now, when we look at age as a factor that influences DID, research indicates that childhood trauma are seen to be as a huge factor. Then, when we look at gender as a factor that influences DID, on one hand it says that females tend inhibit this type of disorder more than males, but then again it all depends, sometimes females rates are much higher than males, and than males have much higher rates. So, it is hard to say exactly which gender id more or less influenced in terms of having dissociative identity disorder.

Environmental and internal influences

Textbook of Psychiatry/Dissociative Disorders/Pathogenesis. (n.d.). Retrieved April 01, 2015, from http://en.wikibooks.org/wiki/Textbook_of_Psychiatry/Dissociative_Disorders/Pathogenesis.

GENETICS

To date, not many studies have been done to determine the genetic predisposition to Dissociative Disorders. Results of existing studies confirm that the dissociation may be partially genetically determined, although results of twin studies are controversial. One study, by Waller, 1997, found no evidence and another study, by Jang, 1998, found 48% to 55% genetic influence. A study by Savitz, 2008, found that there is involvement of COMT Val158Met polymorphism in mediating the relationship between pre-existing trauma and following development of dissociative psychopathology.

NEUROBIOLOGY

In the area of neurobiological research, multiple studies were done that confirm the presence of physiological changes associated with dissociative symptoms. As already mentioned, there is a hypothesis that early psychological trauma or abuse (i.e., stress) can mediate the development of those changes. To date, several neurotransmitter systems have been implicated in the development of Dissociative Disorders: Hypothalamo-Pituitary-Adrenal Dysfunction (HPA), Glutamate/N-methyl-D-aspartate (NMDA) receptor, Serotonin 5-HT2a, 5-HT2c, ?-aminobutyric acid (GABA), and Opioid receptors.
The HPA axis is known to play a central role in medicating the stress response. Several studies on this have been done to date. Most of them presented similar findings showing that individuals with dissociative symptoms have basal HPA-axis hyperactivity with elevated cortisol and diminished pituitary negative-feedback inhibition (Simeon, 2006).
As an extension of this dysregulation due to stress, some research was performed using neuroimaging. In both animal and human studies, stress at a young age has been shown to be associated with changes in the structure of the hippocampus. Smaller hippocampal and amygdalar volumes in patients with dissociative symptoms have been reported by some researchers (Vermetten, 2006). Decreased hippocampal volume may be explained by stress exposure; the hippocampus is a major target organ for glucocorticoids, which are released during stressful experiences, and prolonged exposure to glucocorticoids can lead to progressive atrophy of the hippocampus. The exact mechanism that can lead to smaller amygdalar volume is unclear. It is possible that other neurotransmitters play a role in this change. In their study, D’Souza et al. (2006) proposed that dissociative symptoms, similar to psychosis, may be related to the inhibitory (GABAergic) deficits that cause unopposed stimulation of serotonin receptors. Lysergic acid diethylamide (LSD), dimethyltryptamine (DMT) work as agonists of serotonin 5-HT2a and 5-HT2c receptors, again suggesting a possible mediating role for serotonin in dissociation.

A similar mechanism might underlie cognitive effects of NMDA receptor antagonists, such as ketamine, which was found to cause a profound dissociative state in healthy individuals. NMDA receptors are widely distributed in the cortex, as well as in the hippocampus and the amygdala; therefore, it is possible that diminished NMDA-related neurotransmission may be related to dissociative states. The effect of cannabinoids confirm this hypothesis, as they have been shown to block NMDA receptors at sites distinct from other noncompetitive NMDA antagonists (Feigenbaum, 1989) and still cause dissociative symptoms.
Several studies using positron emission tomography have been performed. One showed that depersonalization severity was correlated with an increase in cerebral blood flow (CBF) in the right frontal cortex and anterior cingulate, and a decrease in subcortical flow in the amygdala, hippocampus, basal ganglia and thalamus (Mathew, 1999). Reinders (2006) found psychobiological differences for the different dissociative identity states. Regional cerebral blood flow (rCBF) data revealed different neural networks to be associated with different processing of the neutral and trauma-related memory script. Sar et al. (2001, 2007) demonstrated decreased bilateral perfusion in frontal and occipital regions among patients with dissociative identity disorder (DID) compared with a group of non-traumatized healthy individuals, which the researchers think provides some validation of the existence of dissociative identity disorder as a distinct diagnostic category. These results also confirm the "orbito-frontal model" of Dissociative Identitiy Disorder proposed by Forrest (2001), which hypothesizes that the orbito-frontal cortex plays a critical role in the development of dissociative identities due to its inhibitory function. Research regarding the neurobiology of dissociative disorders is ongoing and continues.

PSYCHOLOGICAL FACTORS

There is growing interest in the role of early childhood disturbances of attachment and parenting in the development of dissociation (Dutra, 2009). From that article: "Bowlby, in 1973, suggested that infants may internalize dissociated or unintegrated internal working models of their primary caretakers, as well as of themselves. Main and Solomon (1990) then documented the existence of contradictory, confused, and disoriented behavior among some infants in the presence of the parent when needing comfort. These were termed disorganized/disoriented attachment behaviors. Subsequent meta-analyses have confirmed the association between infant disorganized attachment behavior, parental maltreatment, parental psychopathology, disturbed parent-infant interaction, and childhood behavior problems (Madigan et al. 2006; van IJzendoorn et al. 1999). Liotti (1992) further noted that there are suggestive parallels between infant disorganization and adult dissociation in that both phenomena reflect a pervasive lack of mental or behavioral integration." As discussed above in the "Biological Factors" section, early childhood trauma, loss or abuse are strongly correlated with the development of dissociative symptom. Along with the traumagenic theory of development of dissociative disorders, especially Dissociative Identity Disorder (DID), there are iatrogenic and pseudogenic positions (Reinders, 2006). The iatrogenic position takes the view that Dissociative Identity Disorder symptoms are often induced during psychotherapeutic treatment where there is good therapeutic alliance, high therapeutic dependency and high suggestibility. Therapy may contribute to the creation of false memories, and then separate and distinct identities, leading to the creation of Dissociative Identity Disorder phenomena. Laney and Loftus (2005) and Loftus and Davis (2006) describe cases where individuals that claimed to be amnestic had false memories that were "reconstructed" during therapy. Pseudogenic Dissociative Identity Disorder includes subjects who are simulating DID without any therapeutic intervention. It is a conscious process used for achieving secondary gain.

SOCIAL/CULTURAL FACTORS

There is a growing body of research targeted at possible cultural differences, significance of the place of origin or other ethnical background in the development of dissociative disorders. Racial and ethnic differences were studied by Douglas (2009) in a non-clinical population and the results indicated differences in dissociation as a function of race: Africans and Asian Americans reported significantly higher rates of dissociation compared to Whites. A substantial proportion of recently published cases of dissociative disorders showed that immigration is an important factor in the development of DID (Staniloiu, 2009). Fatalism, trance, possession, spiritual and healing practices (Seligman, 2008; Moreira-Almeida A, 2008) are being studied. All this research can advance the ethnographic studies of dissociation and highlights the importance of social and cultural aspects of its development.

JURISPRUDENCE

One of the social aspects of debate is implication of DID in jurisprudence. This illustrates how iatrogenic and pseudogenic theories of development DID may be implicated. There are three categories of legal complications related to the diagnosis of dissociative disorders that the court system has to deal with (Reinders, 2006). Firstly, the individual suffering from DID may accuse another person of sexual or physical abuse. Secondly, the individual suffering form DID may claim not to be responsible for crimes committed in a different identity state. And, thirdly, if a person has multiple identities, which one can legally represent that person?

FAMILIES

To date, several family environmental factors were found to be associated with dissociation, including lack of parental care and warmth (Mann and Sanders, 1994; Modestin et al. 2002), inconsistent discipline (Braun and Sachs, 1985; Mann and Sanders, 1994), and poor relationship between parents (Maaranen et al. 2004). Additionally, all of these factors were also associated with abusive environments (Wolfe, l985). Familial and social support should be recognized as important protective factors against the development of DID (Korol, 2008).

This section looks at external and environmental factors that may influence dissociative identity disorder. These factors include social/cultural, families, psychological, biology, etc. This is relevant information because now the question comes to the "nature versus nurture" theory where these factors may assist one to to understand what may have influenced this type of disorder. If they may have been born with this disorder or have adapted it through your surroundings. It is really important to understand that you need to know what may have influenced this type of disorder as early as possible, so that one could understand this disorder, how to deal with it, and to stop or slow down the process of this disorder.

Epidemiology

Web MD. (n.d.). Dissociative Identity Disorder (Multiple personality Disorder). Retreived from http://www.webmd.com/mental-health/dissociative-identity-disorder-multiple-personality-disorder

Chu, J., Dill, D.D. (1990). Dissociative symptoms in relation to childhood physical and sexual abuse. The American Journal of Psychiatry. 887-892.

Johnson, J.G., Cohen, P., Kasen, S., Brook, J.S. (2006). Dissociative disorders among adults in the community, impaired functioning, and axis I comorbidity and II. Journal of Psychiatric Research. 131-140.

Dissociative identity disorder is a psychosomatic response as a result of internal and environmental pressures, such as emotional abandonment and harm.There is a notable relationship between youth hood abandonment and dissociative identity disorders. Nearly 99% of individuals possessing dissociative identity disorder have experienced life-endangering events before the age of nine; an important stage of youth hood. Although there is an absence of sexual or other forms of physical abuse, dissociation disorder still manifests in individuals who have suffered from emotional abuse. (WebMD, n.d.) This disorder impedes personality construction as it may implement difficulties with regards to information processing such as interference with consolidation due to acute stimulation and an inadequacy of judicious attention. On the contrary, nevertheless, this disorder may initiate a mental regression in order to avert conflicts and complications.

etiology-of-did-2.png?w=845&h=553

(Image describing the aetiology of Dissociative Identity Disorder)

Because individuals who have experienced emotional abuse and neglect are unable to flee pain in a physical manner, they opt to flee cognitively through the means of dissociating in conceptions. Individuals who have suffered emotional abuse use disassociation in order to shield against pain stemming from their abuse. It defends against pain and makes it less intense by altering their perceptions of their abuse and neglect, as if it were experienced by a different individual. This results in depersonalization and derealization, causing individuals to rid themselves of this mistreatment that they no longer want to remember, and to also forgot their abuse. (Chu and Dill, 1990, p. 41)

According to (Johnson, Cohen, Kasen, and Brook, 2006, p.117), studies have shown that a prevalence rate of dissociative identity disorder of 1% to 3% exists within the general population. (Johnson, Cohen, Kasen, and Brook, 2006, p.117). Nevertheless, it is also suggested that this disorder is also regular, impacting approximately 5% to 10% of the general population. Clinical studies in North America, Europe, and Turkey discovered that approximately 1% to 5% of patients present within psychiatric subdivision, adolescent inpatients subdivisions, and facilitations providing therapy to patients who suffer from eating disorders, obsessive compulsive disorders (OCD), and substance abuse may fulfill the Diagnostic and Statistical Manual of Mental Disorders, which is a diagnostic requirement for dissociative disorder. (International Society for the Study of Trauma and Dissociation, 2011, p. 117).

Psychiatric Patients

Out-patients

Carlson, E. B., Putnam, F. W. (1993). Dissociation: Progress in the Dissociative Disorders. APA Psych net. 16-27.

A study was conducted by to evaluate the generality of dissociative disorder amongst an outpatient psychiatric society. A total of 231 English speaking patients ranging from ages 18 to 65 filled out various demographic and individual accounts including: Dissociative Experiences Scale, Traumatic Experiences Questionnaire, and Dissociative Disorders Interview Schedule.The Dissociative Experiences Scale is a 28-element individual account measure for evaluation of precise dissociative experiences. (Carlson and Putnam, 1993, p.16-27) have used a variety of measures such as the Traumatic Experiences Questionnaire, The Dissociative Identity Disorder Interview Schedule, and The Dissociative Experiences Scale in order to discover the frequency and prevalence dissociative identity disorder amongst out patients.

The Traumatic Experiences Questionnaire is a 49-element individual account measure for evaluation of precise experiences in four fields:
- child-hood physical abuse
- child-hood sexual abuse
- observing of domestic violence, and adult retraumatization

The Dissociative Identity Disorders Interview Schedule is a 131-element design interview used to evaluate DSM-IV detects of:
- somatization disorder
- major depression
- borderline personality disorder
- alcohol and drug abuse
- and the five DSM-IV dissociative disorders
- trauma history
- assumed qualities in relation to dissociative identity disorder, such as Schneiderian indications

The Dissociative Experiences Scale is a 28-element individual account measure for evaluation of precise dissociative experiences (Carlson and Putnam, 1993, p.16-27).

Demographic characteristics of the total population
n=diagnosis
- 50% of those diagnosed, n=107 out of 216 evaluated subjects were of Hispanic descent
- 23% of those diagnosed, n=50 out of 216 evaluated subjects were African American descent
- 20% of those diagnosed, n=43 out of 216 evaluated subjects were of Caucasion descent
- 64% of those diagnosed, n=147 out of 231 evaluated subjects were female
- 38% of those diagnosed, n=81 out of 215 evaluated subjects were inadequately educated and did not possess a highschool diploma
- 98% of those diagnosed, n=194 out of the 203 evaluated subjects were Medicaid ensured
- 82% of those diagnosed, n=174 out of the 211 evaluated subjects were unemployed or were not working

Of these patients, the diagnoses comprised:
- principally depressive disorders (46%, N=104 of 228)
- psychotic disorders (15%, N=34 of 228)
- anxiety disorders (8%, N=17 of 228)
- bipolar disorders (7%, N=15 of 228)
each for 2% or less of the patients (containing Post Traumatic Stress Disorder in 2% (N=5 of 228) and dissociative disorders in 0.4% (N=1 of 228). (Foote, Smolin, Kaplan, Legatt, Lipschitz, 2006, p. 625).

Of these patients, 82 complete the Dissociative Disorders Interview Schedule. These 82 patients were compared with the 149 other patients who haven’t fulfilled the Dissociative Disorders Interview Schedule. Nevertheless, they did not fluctuate drastically with regards to any demographic history including:
- gender
- education
- income measured by Medicaid status

The groups; 82 of the patients who completed the Dissociative Disorders Interview Schedule and the 149 patients who have failed to complete Dissociative Disorders Interview Schedule did not portray any fluctuation of:
- Childhood sexual mistreatment, conveyed through Traumatic Incidents Questionnaire score
- childhood physical abuse
- detachment
1table.jpg
Patients' perspectives of dissociative identity disorders.

Excessive levels of suffering and separation were present within both groups. The total group of 231 subjects possessed:
- a 59% pervasiveness of individual informed childhood physical harm (N=103 of 175, N= diagnoses)
- a 34% prevalence of individual informed childhood sexual manipulation (N=58 of 168, N=diagnosis)
- a mean Dissociative Experiences Scale score of 20.9 (SD=18.7).

Twenty-four (29%) of the 82 patients (95% confidence interval [CI]=19.4%–39.0%) who were interviewed met the criteria for a DSM-IV dissociative disorder diagnosis, and the diagnoses distributed as follows:

- dissociative amnesia, N=8 (10%);
- dissociative disorder not otherwise specified, N=7 (9%);
- dissociative identity disorder, N=5 (6%);
- and de- personalization disorder, N=4 (5%)

2table.jpg

Psychiatric In- patients

Tutkun,H., S ̧ar, V., Yargιç,I.L., Özpulat, T., Yanik,M., Kiziltan, E. (1998). Frequency of Dissociative Disorders Among Psychiatric Inpatients in a Turkish University Clinic. Am J Psychiatry. 800-805

241 patients admitted to a psychiatric clinic in a university hospital. Of those patients, 166 (68.9%) fulfilled the surveys (63.6% of all admissions). Patients possessing dissociative disorders who achieved a score higher than 30 were diagnosed based on the Dissociative Disorder Interview Schedule. According to (Tutkun, Sar, Yargiç, Özpulat, Yanik, and Kiziltan, 1998, p.803), Nine patients (seven women and two men) were identified as possessing dissociative identity disorder by scientific testing. According to (Tutkun, Sar, Yargiç, Özpulat, Yanik, and Kiziltan, 1998, p.803), 82% of patients possessing dissociative disorders also possessed dissociative identity disorder while. Nevertheless, 0% of patients who did not have dissociatie disorder also did not have dissociative identity disorder. With regards to this study, the rate of dissociative disorder among psychiatric inpatients comprises 10%, with 5.4% these patients meeting the standards for dissociative identity disorder. (Tutkun, Sar, Yargiç, Özpulat, Yanik, and Kiziltan, 1998, p.803) Have also found that circa 10% of the psychiatric patients in the Turkish University hospital have met the standards for chronic complex dissociative disorder, and half of these patients have met the standards for dissociative identity disorder.

Many of the patients possessing dissociative disorders in this study group possessed multiple coexisting psychiatric disorders rendering to the organized interview. High frequencies of these disorders were present:
- comorbid borderline personality disorder
- current or past episode of major depression
- somatization disorder.

Saxe G.N., van der Kolk B.A., Berkowitz R., Chinman G., Hall K., Lieberg G, Schwartz J. (1993). Dissociative disorders in psychiatric inpa- tients. Am J Psychiatry. 1037–1042

(Saxe et al. 1990, p. 1038) discovered:
- PTSD was also common amongst inpatients possessing a dissociative disorder
- Self damaging behavior (ex. as self-disfigurement
- suicide efforts,
- substance abuse
- childhood trauma

Therefore,according to Tutkun, Sar, Yargiç, Özpulat, Yanik, and Kiziltan, 1998, p.804 patients possessing a dissociative disorder portrayed higher frequencies of childhood distressing occurrences.

q313t2.jpeg

Women

Sar, V., Akyük, G., Dogun, U. (2007). Prevalence of dissociative disorders among women in the general population. Psychiatric Research. 169-176

Sur, Akyüz, Dogan, 2007, have conducted a study evaluating the prevalence of dissociative disorders among women in the general population in central Turkey. The have examiners have provided The Dissociative Disorders Interview Schedule, the Borderline Personality Disorder section of the structured clinical interview for DSM–III-R Personality disorder, and the PTSD module of the organized clinical interview for DSM–III-R to a total of 62 women who resided in 500 homes.
The researchers have discovered that 18.3% of the participants, a total of 115 in total, possessed a lifetime diagnosis of dissociative disorder. Nevertheless, an indefinite dissociative disorder was conjoint amongst 8.3% of the population whilst 1.1% of the population possessed dissociative identity disorder.
This study is important as it allows others to understand the prevalence of this disorder and its frequency rate. Participants possessing dissociative disorder also suffered from:
- borderline personality disorder
- somatization disorder
- major depression
- PTSD
- history of suicide efforts at a higher frequency compared to that of patients who were not diagnosed with dissociative disorders

The examiners have also observed that women who suffered from the following were prone to developing dissociative identity disorders:
- childhood sexual exploitation
- physical neglect
- emotional abuse

Children

Putnam, F.W. (1993). Dissociative disorders in children: Behavioral profiles and problems. Child Abuse and Neglect. 39-45

Researcher Frank W. Putnam has conducted a study to observe the relationship between childhood distress and manifestation of dissociative disorders in adults. Many clinicians are now discovering dissociative disorders in children, causing them to experience symtoms such as:
- amnesias
- turbulences in sense of self
- trance-like states
- hasty modifications in disposition and behaviour
- mystifying transferals in admission to knowledge, memory, and skills
- auditory and visual hallucinations
- vivid imaginary friendship in children and adolescents

Absolute levels of dissociative capacity peaks at approximately age nine to ten years old. Important stressors may cause a child to trigger pathophysiological symptoms such as:
- amnesia
- multiple personality disorder or dissociative identity disorder

It is often difficult to diagnose a child with dissociative disorders because they are unable to report any unusual behaviour that they have been exhibiting.

A communal situation described by parents is hearing many children playing and speaking in a different room when in actuality, the child is completing the roles of others with diverse voices. Another scenario is when a child violently argues with themselves.

ZeroSixtyFive. (2015, April 6). Multiple Personality Disorder. Retrieved from: https://www.youtube.com/watch?v=Isi90uiPDCE

This video depicts many individuals who suffered from dissociative identity disorders. Although they are adults, they possess alters of young children.

Controversy

The mini video clip below presented by CBS, shows the hardships for patients with DID as well as the controversy on this disorder. DID is a very controversial disorder and being able to understand both sides of the debate on if this disorder is real or not provides the viewer with a better understanding of what position they might take. This video clip is very good in providing an unbiased account and showing key arguments for and against the validity of DID.

CBS. (2015, April 11). Multiple Personalities. Retrieved from: https://www.youtube.com/watch?v=gfiB82OUXf0

Here is a short synopsis about what the video clip entails:

Dissociative Identity Disorder is among one of the most controversial disorders. There are some mental health care professionals who believe that the disorder is a mere fabrication. After the 1970’s and the release of two very popular novels and movies in relation with DID, the number of reported cases of DID increased significantly. Is this just a fad? Or did people simply not understand what they were experiencing pervious to the release of information on DID?

Paul R. McHugh, professor and former head of psychiatry at John Hopkins Medical School, featured in the film below, believes that a psychiatrist can easily induce and drive the idea that a patient has DID. He also believes that DID is a creation of society that has manifested from media, and that personality and trauma are separate and have no co-relation. Nadean Cool, featured in the video, sued her psychiatrist, Kenneth C. Olson, for misdiagnosing her as suffering from multiple personality disorder. Although this may be the case Dr. Richard Kluft, and many others, disagree with the notion that DID is not a disorder. They believe that it is a “defense mechanism” of the body trying to forget early child hood trauma. There have been journals and scientific evidence that support the validity of DID, as well as being recognized in the DSM V.

Case studies

Abdel-Aziz, S. (2005). Multiple Personality Disorder A Review and a Case Study. Journal of the Islamic Medical Association of North America, 61-63.

“Kathy,” a 29 year old Caucasian female was admitted to the hospital due to overdosing on sleeping pills. Her husband had discovered her at this state, and it was due to the fact that Kathy was unable to manage the accountability of motherhood and marriage. On her husband’s account, he had several times found food burning in the oven. At one point, “Kathy” was saved from the fire, but she did not know who held responsibility. She also refuted possessing sexual relations with her husband, although he was the father of her three children.
When “Kathy” was four years old, she discovered her father naked with her neighbor, who was only five years old. Her father had persuaded her to join their “sexual play,” telling her to take off her clothes. This continued for nearly five years. As a result, she cried due to guilt, unable to accept the activity that had occurred. Nevertheless, she had received relief when she accredited the activity to someone called “Pat.”
When “Kathy” was nine years old, her mother had discovered her sexual activity with her father. As a result of this, the mother resented the father, and decided to keep her child in her bed with her every night. Afterwards, the mother began to develop a sexual attachment with her daughter, in what she considered to be much safer. “Kathy” could not accept this, thus she ascribed this activity to “Vera,” and this sexual relationship continued for nearly five years.
When “Kathy” was 14 years old, her father’s best friend had raped her. She then began to refer to herself as Debbie.
Hospital records explain that “Kathy” portrayed combination of depression, dissociation, petulance, and widespread handling. A therapist worked with “Kathy” and recommended the treatment of hypnosis. This therapist attentive on Debbie, as he believed that was the dominant personality. The therapist also encouraged Debbie to speak of “Pat” and “Vera” strengthening their characters as prevailing personalities. She stopped this therapy and denoted to herself as “Kathy”, “Vera”, “Pat”, and Debbie at altered periods.
When “Kathy” was eighteen years old, she had become devoted to a boyfriend, however her mother did not allow her to meet with the boyfriend, because she warned her daughter that men cannot be trusted, whilst using her marriage as a reference. As result, “Kathy” became fearful, and was unable to trust both parents. She then moved away. She did not have any money, thus opted to prostitute. She then began to refer to herself as “Nancy.” However, “Debbie” precluded Nancy” and forced her to overdose on sleeping pills.

Legal issues

Sinnott-Armstrong, W., Behnke, S. (2001) Criminal Law and Multiple Personality Disorder: The Vexing Problems of Personhood and Responsibility. C. CAL. Interdisc. 277-296

Multiple personality disorder, or dissociative identity disorder grants problematic issues in court as they try to evaluate the criminal responsibility of the person possessing dissociative identity disorder. Conventional evaluation for criminal accountability does not report characteristics of MPD. The criminal justice system therefore is unable to prove accountability of the individual possessing dissociative identity disorder through the means of assessing whether individuals can comprehend or realize the penalties of their events. A particular case, Denny-Shaffer had concealed herself as a medical student and kidnapped a newborn baby from a hospital nursery. She the transported the baby to a different state, and arrived at her ex-boyfriends home. She called him to come home from work, and she explained that she allegedly gave birth to the infant that she had kidnapped, and she had a placenta and blood from the hospital as proof that she has given birth. The ex-boyfriend had ordered her to leave, and thus she had travelled to her family’s home. Subsequently, she travelled back to her place of origin. The police caught her, and successfully returned the infant to its parents. As a result, she was charged with kidnapping and transferring the infant across state lines.
In her defense, Denny-Shaffer exclaimed that she was her dominant personality, Gidget, was incognizant and thus unaware of her actions of that time. The court concluded that Denny-Shaffer grieved from an acute cognitive illness, and during the time of the kidnapping, her dominant personality was not in control. She was not aware that her alter personality was in regulation, controlling all the physical activities. Therefore, the dominant personality was unable to comprehend or realize the penalties of the events that the alter personalities controlled.

Sasks, E.R., Behnke, S.H. (1997). Jekyll on Trial: Multiple Personality Disorder and Criminal Law. New York University Pres.

Elyn Sasks had present a “Theory of general non responsibility” of persons with Multiple Personality Disorder or Dissociative Identity Disorder.
According to Sasks, individuals possessing Multiple Personality Disorder or Dissociative Identity Disorder are not accountable for their actions unless their total alters have consented to the crime, which occurs when an alter either was involved in the illegal crime, or was able to avert this action, and did not, thus they should not be alleged criminally accountable.

Conclusion

To conclude, we hope you have a better understanding of the topic on Dissociative Identity Disorder and its controversy. We have provided both basic information on this topic, and have clearly touched upon both sides of this controversial topic. Case studies have been provided as well as documentaries for further information. We have researched, analyzed and documented all of our information for the purpose of your article. There are over 18 sources presented which can be used and provide aid during your writing process. Our team would like to thank you for allowing us this opportunity to work with you and hope that this page proves to be beneficial for you.

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