Adam Bohannon's List: Dissociative identity disorder research

• The diagnosis requires that at least two personalities routinely take control of the individual's behavior and that there is associated memory loss that goes beyond normal forgetfulness, often referred to as losing time or acute Dissociative Amnesia^[1]
• As a diagnosis, DID remains controversial. For many years DID was regarded as a North American phenomenon^[3][4][5] with the bulk of the literature still arising there. However, research demonstrates a lack of consensus belief in the validity of DID amongst North American psychiatrists.^[6][7] Practitioners who do accept DID as a valid disorder have produced an extensive literature with some of the more recent papers originating outside North America. Criticism of the diagnosis continues with Piper and Merskey describing it as a culture bound and often iatrogenic condition which they believe is in decline.^[5][8]
• Dissociation is recognized as a symptomatic presentation in response to trauma, extreme emotional stress, and, as noted, in association with emotional dysregulation and Borderline Personality Disorder^[14]. Often regarded as a dynamic sub-symptomatology, it has become more frequent as an ancillary diagnosis, rather than a primary diagnosis.^{[citation needed]}

• The MPD/DID epidemic in North America

   

  Paris^[15] in a review offered four possible causes for the sudden increase in people diagnosed with MPD/DID:

   
   
  1. The result of therapist suggestions to suggestible people, much as Charcot's hysterics acted in accordance with his expectations.
   
  2. Psychiatrists' past failure to recognise dissociation being redressed by new training and knowledge.
   
  3. Dissociative phenomena are actually increasing, but this increase only represents a new form of an old and protean entity: "hysteria."
   
  4. Powerful psychosocial forces are changing the psychological balance of individuals so as to make dissociative experiences more common.
   
   

  Paris opines that the first possible cause is the most likely.
• Unlike other diagnostic categorizations, there is very little in the way of objective, quantifiable evidence for describing the disorder. This makes the disorder itself subjective, as well as its diagnosis.

• The main points of disagreement are these:

   
   
  1. Whether MPD/DID is a real disorder or just a fad.
   
  2. If it is real, is the appearance of multiple personalities real or delusional.
   
  3. If it is real, whether it should it be defined in psychoanalytic terms.
   
  4. Whether it can, or should, be cured.
   
  5. Who should primarily define the experience—therapists, or those who believe that they have multiple personalities.
• Although many experts dispute the existence of this controversial diagnosis, Dissociative Identity Disorder has been attributed by some to the interaction of several factors: overwhelming stress, dissociative capacity (including the ability to uncouple one's memories, perceptions, or identity from conscious awareness), the enlistment of steps in normal developmental processes as defenses, and, during childhood, the lack of sufficient nurturing and compassion in response to hurtful experiences or lack of protection against further overwhelming experiences^[17]
• History
• In 1910 Bleuler introduced the term "schizophrenia" to replace "dementia praecox" and a review of the Index Medicus from 1903 through 1978 showed a dramatic decline in the number of reports of multiple personality after the diagnosis of schizophrenia "caught on," especially in the United States.^[65]
• As media coverage spiked, diagnoses climbed. There were 200 reported cases of MPD from 1880 to 1979, and 20,000 from 1980 to 1990.^[66] Acocella reports that 40,000 cases were diagnosed from 1985 to 1995.^[67] The majority of diagnoses are made in North America, particularly the United States, and in English-speaking countries more generally^[68] with reports recently emerging from other countries.^{[50][51][52][53][54][57][58]}

8 more annotations...

• 
  - Adam Bohannon on 2007-09-18