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Dissociative Identity Disorder

DSM-IV-TR Definition and Criterion of Diagnosis
Dissociative Identity Disorder (formerly Multiple Personality Disorder) is characterized by the presence of one or more distinct identities or personality states that recurrently take control of the individual's behavior accompanied by an inability to recall important personal information that is too extensive to be explained by ordinary forgetfulness. It is a disorder characterized by identity fragmentation rather than proliferation of separate personalities.

Diagnostic criteria for 300.14 Dissociative Identity Disorder
 A. The presence of two or more distinct identities or personality states (each with its own relatively enduring pattern of perceiving, relating to, and thinking about the environment and self). B. At least two of these identities or personality states recurrently take control of the person's behavior. C. Inability to recall important personal information that is too extensive to be explained by ordinary forgetfulness. D. The disturbance is not due to the direct physiological effects of a substance (e.g., blackouts or chaotic behavior during Alcohol Intoxication ) or a general medical condition (e.g., complex partial seizures). Note: In children, the symptoms are not attributable to imaginary playmates or other fantasy play. 

Other Information about Dissociative Identity Disorder from the DSM:

 * Reflects a failure to integrate various aspects of identity, memory, and consciousness
 * Each personality state may be experienced as if it has a distinct personal history, self image, and identity. Including a separate name
 * Usually there is a primary identity that carries the individual's given name and is passive, dependent, guilty, and depressed.
 * Alternates generally have different names and characteristics that contrast with the primary identity (e.g. are hostile, controlling, and self destructive)
 * Identities can differ in age, gender, vocabulary, general knowledge, or predominant affect.
 * The number of identities can range from 2 to over 100
 * Half the reported cases include individuals with 10 or fewer identities,

Associated Features:

 * Reports of severe physical and sexual abuse (especially in childhood)
 * Controversy surround the accuracy of such reports, because childhood memories may be subject to distortion and some individuals with this disorder are highly hypnotizable and especially vulnerable to suggestive influence
 * however, these reports are confirmed by objective evidence
 * Individuals with DID may manifest post-traumatic symptoms (e.g. nightmares, flashbacks, and startle responses)
 * Individuals may also have symptoms of Mood, Substance Related, Sexual, Eating, or Sleep Disorders.
 * Self-multilative behaviors, impulsivity, and sudden and intense changes in relationships may warrant a concurrent diagnosis with Borderline Personality Disorder.
 * Some believe the syndrome is over diagnosed in individuals who are highly suggestible.

Famous Cases
The most famous case of Dissociative Identity Disorder is undoubtedly the case of Shirley Mason, or "Sybil" as she is cause in the fictionalized recounting of her life in a 1973 book and a 1976 movie and the remake of the movie done in 2007. (Clip of the 1976 movie found here). Sybil was one of the earliest reported cases of DID. Her story (and her 16 personalities) is what made DID famous--to the extent that she is sometimes called the Jesus Christ of Dissociative Identity Disorder. Sybil claims her disorder was the result of severe physical and sexual abuse at the hands of her mother (who was later deemed Schizophrenic). Sybil's first Alter was named Victoria, and was formed when Sybil was only three years old.Vicky was the representation of Sybil's poise and confidence. "Peggy Louisiana" is another of Sybil's original alters; she embodies the rage and hatred Sybil feels towards her mother and is openly hostile and aggressive. Sybil also had two male alters in Sybil's arsenal. Sid and Mike both split from Peggy and embodied the hatred of Sybil's mother (and females in general) and were form in reaction to the male authority figures in Sybil's life (her father and grandfather). There's lots of controversy surrounding whether or not Sybil really had DID.

Another famous case of DID is that of Eve White. Eve's story is told in the 1957 movie //The Three Faces of Eve//. Eve White is an every day house wife, usually calm and conservative, but at times she becomes Eve Black. Eve Black is a wild, carefree woman with no love for White's husband, daughter, or life. The two Eves are later joined by Jane who embodies the best of both of the Eve and is able to regulate between them. It was decided that Jane was the best suited for living every day life, and she became dominant over the other two.

A lesser know case of DID is Elizabeth Carlson's. In 1989, Carlson was in a psychiatric hospital receiving treatment of sever depression, when psychiatrist Diane Humenansky suggested that perhaps she wasn't suffering from depression, but from DID. Under the care of Humenansky, Carlson learned of so many identities she supposedly had that she lost count. She recovered memories of being brought up in a family of cult memories, that aborted women's babies and ate the after birth. She was on Xanax, Valium, Ativan, Pemelor, Desyrel, Prozac, and Restoril, often in heavy doses. When she stopped receiving treatment from Humenansky and was suddenly better, she sued the doctor and was awarded $2.4 million for damages. Carlson was only one of many women diagnosed with DID as the supposed result of satanic ritual abuse.

Another case worth mentioning is that of Cathy O'Brien. Please see this video.

DID in Popular Culture
Dissociative Identity Disorder has appeared in many popular movies and television shows.


 * Oprah Winfrey has, on multiple occasions, interviewed women with DID. One being Truddi Chase, the woman with 92 personalities.
 * The popular show //Criminal Minds// have done multiple episodes in which the criminal had DID. One of these episodes is about Adam Jackson, who created a female personality by the name of Amanda in order to deal with abuse from his stepfather after the death of his mother. Amanda begins killing men while Adam is unaware. At the conclusion of the episode, in order to protect Adam, Amanda completely suppresses her male half and takes complete control on his body.
 * An episode of //Law and Order: Special Victim's Unit// details the case of Janis, who has four alternate personalities and is facing trial of murdering her parents. Janis is found not guilty by reason of mental defects. It is later discovered that Janis does not have DID, but this was a carefully concocted plan by her and her sister to get away with murdering their parents. (The sister is arrested to conspiracy.)
 * In the movie //Hide and Seek,// a man named David learns that his daughter's imaginary friend "Charlie" is actually his own split personality.
 * The movie //Fight Club// has a narrator with multiple personalities.

Controversy
There's a lot of controversy over whether or not Dissociative Identity Disorder is in fact a real disorder. Nearly all of the patients treated for DID are highly susceptible to hypnosis, suggestions, and trances. With these patients being so mentally vulnerable, it would be easy for their psychiatrist to plant ideas into their heads and have them take it as fact. Poorly worded questions can be all that needed for a patient to convince themselves that they have this illness. Since the trauma that causes DID usually occurs in childhood, and memories of childhood are often vague, it is easy for the patients to fabricate memories to back up their assumed illness.

Cases like that of Carlson (though that case is admittedly very old and happened at a time where DID was relatively new and so was the hot button for diagnosis) does not help to give validity to the idea of DID. Also, with DID becoming so mainstreamed, many people can become a bit hypochondriac about it. With the chance of people taking the //Law and Order// route of faking DID as a legal defense, it becomes even harder to believe.

Then there's the question of at which point does simple mood swings become distinguishable as a separate personality all together. That is to say, if a person is seeing a psychiatrist and their personality shifts from one visit to another, how do you draw the conclusion of DID without first planting the suggestion of it in the patient's head?

A lot of people believed that the case of Sybil was just a scheme to make money. If the most popular case of this disorder is so controversial, how can the disorder itself be taken at face value?

My Opinion
I do believe DID to be a real disorder, but only within certain criteria. I don't think DID should ever be the primary diagnosis. Since it share traits with so many other disorders (that are not so controversial), one of those other disorders should be looked at first. Not saying to purposely misdiagnose a patient simply to avoid diagnosing DID, but Dissociative Identity is often comorbid. Chances are diagnosing a Mood disorder or a post-traumatic disorder would actually be correct. Also, I think there must be evidence severe abuse before the diagnosis. Making the diagnosis and then trying to coax the patient into remembering the events that caused the disorder will only lead the the fabrication of the memories. Have evidence of the abuse before drawing the conclusion of DID. But since memories of the trauma is often suppressed with DID, the evidence of the abuse most likely will need to be gathered from an outside source. Once the source provides indisputable evidence, then it's ok to coax the memory from the patient.

Citations:
Acocella, J. R. (1999). Creating hysteria: women and multiple personality disorder. San Francisco: Jossey-Bass Publishers.

Diagnostic and statistical manual of mental disorders: DSM-IV-TR. (4th ed.). (2000). Washington, DC: American Psychiatric Association.