Johns Hopkins Psychiatry Guide

Dissociative Identity Disorder

Matthew E. Peters, M.D., Glenn Treisman, M.D., Ph.D.
Dissociative Identity Disorder is a topic covered in the Johns Hopkins Psychiatry Guide.

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DEFINITION

  • A controversial diagnosis, previously known as multiple personality disorder (MPD)
    • Renamed dissociative identity disorder (DID) in DSM-IV [1]
    • Dissociative identity disorder is classified under the Dissociative Disorders section of the Diagnostic and Statistical Manual of Mental Disorders, 5th Edition (DSM-5) [2].
    • Seen by many critics as a form of hysteria, often compared with pseudoseizures and conversion paralysis
  • The disorder was popularized by successful books that were purportedly clinically true accounts but later shown to be fictionalized:
    • In 1954, a case of multiple personality disorder was reported and later made into a book and a movie, The Three Faces of Eve [3] [4].
    • In 1973, the book Sybil [5] was published by Flora Rheta Schreiber, a psychiatrist, which was made into a very successful movie and was used as a clinical template for many of the elements of MPD.
    • Subsequently, many of the reported elements of the case have been shown to be misrepresented.
    • Another book, Michelle Remembers [6], connected multiple personality disorder with ritualized satanic sexual abuse.
  • At the core of the assertions about the disorders were the concepts that memories of horrendous sexual abuse in childhood were “repressed” and could be later “recovered” with various forms of therapy including hypnosis and suggestion.
  • The proponents of the disorder also describe "dissociation," a state of mind in which parts of personality are compartmentalized so that they are inaccessible to each other.
  • Dissociative disorders are described as a disruption of and/or discontinuity in the normal integration of consciousness, memory, identity, emotion, perception, body representation, motor control, and behavior [2].
  • Often attributed to prior trauma (perhaps as many as 90% of those affected), with some saying that these memories must be "recovered," as they are not always remembered by the "victim."
  • The defining feature of dissociative identity disorder is "the presence of two or more distinct personality states or an experience of possession" [2].
  • Studies that have characterized the condition have been criticized as methodologically flawed and based on circular arguments.
    • Pope et al. (2006) [7] found there to be a sharp peak in articles on DID in the late 1990s followed by a steep decline, leading the authors to conclude that DID was a fad that was never accepted by the scientific community.
    • In a more recent review of the literature, Boysen and VanBergen (2012) [8] concluded that the output of research on DID is low, with stable levels from 2000 to 2010, and that research has continued to be unable to provide convincing evidence regarding cases outside of treatment settings.
  • There are two broad, opposing models for the underlying cause of DID [9]:
    • Dynamic/developmental model: the development of alternate identities occurs as a result of the inability of traumatized children to develop a unified sense of self that is maintained across various states.
    • Sociocognitive model: DID is a socially constructed, learned condition that results from the therapist’s cueing (e.g., suggestive questioning regarding the existence of possible alternative personalities), media influences (e.g., film and television portrayals of DID), and broader sociocultural expectations regarding the presumed clinical features of DID.
      • This model accepts that some people, without conscious intention, develop the behaviors seen in DID as a matter of suggestion, conditioning, and underlying vulnerability.

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Last updated: December 9, 2014