D.I.D. – M.P.D.

Basic Information on Dissociative Identity Disorder with sections on Basic Information on DID from the DSM‑IV‑TR, The History of DID/MPD, Diagnosing DID, Responses to those that state that DID is iatrogenic or a social construct,  MPD/DID connection to severe abuse, Recent information and DID resources  – http://ritualabuse.us/research/did/basic-information-on-didmpd/

From the DSM-IV-TR (American Psychological Association (2000). Diagnostic and statistical manual of mental disorders (4th ed. text revision).Washington, D. C .)

DID is defined in the DSM-IV-TR as the presence of two or more personality states or distinct identities that repeatedly take control of one’s behavior. The patient has an inability to recall personal information. The extent of this lack of recall is too great to be explained by normal forgetfulness. The disorder cannot be due to the direct physical effects of a general medical condition or substance.

DID entails a failure to integrate certain aspects of memory, consciousness and identity. Patients experience frequent gaps in their memory for their personal history, past and present. Patients with DID report having severe physical and sexual abuse, especially during childhood. There is controversy around these reports, because childhood memories may be exposed to distortion and some patients with DID are highly hypnotizable and vulnerable to suggestive influences. But, the reports of patients with DID are often validated by objective evidence. People that are responsible for acts of sexual and physical abuse may be prone to distorting or denying their behavior.

Physical evidence may include variations in physiological functions in different identity states, including differences in vision, levels of pain tolerance, symptoms of asthma, the response of blood glucose to insulin and sensitivity to allergens. Other physical findings may include scars from physical abuse or self-inflicted injuries, headaches or migraines, asthma and irritable bowel syndrome.

DID is found in a variety of cultures around the world. It is diagnosed three to nine times more often in adult females than males. Females average 15 or more identities, males eight identities. The sharp rise in the reported cases of DID in the U.S. may be due the greater awareness of DID’s diagnosis, which has caused an increased identification of those that were previously undiagnosed. Others believe it has been overdiagnosed in those that are highly suggestible.

The average time period from DID’s first presentation of symptoms to its diagnosis is six to seven years. DID may become less manifest as patients reach past their late 40’s, but it can reemerge during stress, trauma or substance abuse. It is suggested in several studies that DID is more likely to occur with first-degree biological relatives of people that already have DID, than in the regular population.

Sybil and MPD http://sybilandmpd.blogspot.com/ about the book “Sybil” and the life of Shirley Ardell Mason. Sybil was published in 1973 and written by Flora Rheta Schreiber about the treatment of Sybil Dorsett (which is a pseudonym for Shirley Ardell Mason) for what is now called dissociative identity disorder (then called multiple personality disorder). She was treated by her psychoanalyst, Cornelia B. Wilbur. The accuracy of Debbie Nathan’s “Sybil Exposed” book is questioned. Has evidence that the original “Sybil” book is accurate.

Delineates the etiological antecedents of Dissociative Identity Disorder (DID) and enumerates upon the scientific evidence proving the existence of DID. This paper explains the diagnostic criteria of DID, its incidence rates and cross-cultural characteristics, present arguments to counter the idea that suggestibility may be a factor in its misdiagnosis and delineate the data that shows a clear connection between traumatic wartime experiences and dissociation and trauma and DID. It considers the historical development of the debate surrounding DID, including its increased diagnosis around the turn of the last century, reasons for its decline in diagnosis in the mid part of the last century and reasons for its increased diagnosis toward the end of the 20th century. It deliberates upon the claims made by several researchers that DID can be created in the laboratory as well as the critiques surrounding those claims. It discusses the neurobiological evidence proving the connection between DID and certain neurobiological indicators. Included is a discussion of the modern theory of iatrogenic DID and a critique of this theory. A debate about the creation of DID as a social construction and critiques of this theory are presented as well. It concludes, by presenting the argument that the research on DID shows it to be a valid psychiatric diagnosis which robustly meets all the necessary validity requirements. http://ritualabuse.us/research/did/the-etymological-antecedents-of-and-scientific-evidence-for-the-existence-of-dissociative-identity-disorder/

Describes the methods and criteria used for diagnosing and assessing Dissociative Identity Disorder (DID). The symptoms and etiology of DID are discussed. The use of client histories, different psychological tests and the test results of different test items are discussed in terms of their applicability to a diagnosis, as well as their validity and reliability.  Differential diagnoses and their effect on the diagnosis of DID are enumerated upon. The dissociative spectrum and ritual abuse are discussed briefly, in order to help clarify the symptomology and etiology of DID.

Dissociation and Trauma Archives – Full text searchable articles and case studies published in the 1800s and early 1900s. http://boundless.uoregon.edu/digcol/diss/

The official journal of the International Society for the Study of Dissociation (ISSD), published between 1988 and 1997  https://scholarsbank.uoregon.edu/xmlui/handle/1794/1129

An examination of the diagnostic validity of dissociative identity disorder. Gleaves DH, May MC, Cardeña E Clin Psychol Rev. 2001 Jun;21(4):577-608.
We review the empirical evidence for the validity of the Dissociative Identity Disorder (DID) diagnosis, the vast majority of which has come from research conducted within the last 10 years. After reviewing three different guidelines to establish diagnostic validity, we conclude that considerable converging evidence supports the inclusion of DID in the current Diagnostic and Statistical Manual for Mental Disorders. For instance, DID appears to meet all of the guidelines for inclusion and none of the exclusion guidelines; proposed by Blashfield et al.[Comprehensive Psychiatry 31 (1990) 15-19], and it is one of the few disorders currently supported by taxometric research. However, we also discuss possible problems with the current diagnostic criteria and offer recommendations, based on recent research, for possible revisions to these criteria. “In conclusion, despite its long and controversial past, there has been a wealth of research accumulate over the past 10 to 15 years on the DID diagnosis. This research seems to establish the validity of the DID diagnosis.”

pubmed abstract http://www.ncbi.nlm.nih.gov/pubmed/11413868

Objective documentation of child abuse and dissociation in 12 murderers with Dissociative Identity Disorder. Lewis, D.O., Yeager, C.A., Swica, Y., Pincus, J.H., & Lewis, M. (1997). American Journal of Psychiatry, 154, 1703-1710. RESULTS: Signs and symptoms of dissociative identity disorder in childhood and adulthood were corroborated independently and from several sources in all 12 cases; objective evidence of severe abuse was obtained in 11 cases. The subjects had amnesia for most of the abuse and underreported it. Marked changes in writing style and/or signatures were documented in 10 cases.  CONCLUSIONS: This study establishes, once and for all, the linkage between early severe abuse and dissociative identity disorder. Further, the data demonstrate that the disorder can be distinguished from malingering and from other disorders. The study shows that it is possible, with great effort, to obtain objective evidence of both the symptoms of dissociative identity disorder and the abuse that engenders it. http://ajp.psychiatryonline.org/cgi/content/full/154/12/1703

Goettmann, B. A.; Greaves, B. G., Coons M. P. (1994). Multiple personality and dissociation, 1791‑1992: a complete bibliography. Lutherville, MD: The Sidran Press, 85. ISBN 0‑9629164‑5‑5.  is a bibliography. It contains the 1st edition as well as updates through November 30, 1993. Article errors have been corrected when possible. The bibliography is divided up into the following areas: Multiple personalities, Dissociation and Amnesia, Depersonalization and Derealization, Fugue States, and Medico-legal Aspects. Sidran Press. 2nd Edition. – University of Oregon Libraries – http://boundless.uoregon.edu/cdm4/item_viewer.php?CISOROOT=/diss&CISOPTR=38

United States of Tara – Learn More About D.I.D. – Showtime Dissociative Identity Disorder with Richard P. Kluft MD http://www.sho.com/united-states-of-tara

Forensic Aspects of Dissociative Identity Disorder – Google books

The book “Forensic aspects of dissociative identity disorder” looks at the role of crime in the lives of people that suffer from Dissociative Identity Disorder. It is a collection of essays written by several international researchers. It explores the legal, moral, ethical and clinical questions that psychotherapists and other professionals face while working with those suffering from Dissociative Identity Disorder. Authors that have contributed to the book come from the fields of psychotherapy, counseling, psychology, medicine, law, police,  psychoanalysis and social work. Chapters include discussions on ritual abuse, dissociative identity disorder, mind control, extreme abuse, survivor accounts and criminal convictions.



Trauma And Dissociation in a Cross-cultural Perspective: Not Just a North American Phenomenon (Hardcover) by Jr. George F. Rhoades (Editor), Vedat Sar (Editor) Routledge (2006) ISBN-13: 978-0789034076
An international look at the similarities and differences of long-lasting trauma – Trauma and Dissociation in a Cross-Cultural Perspective examines the psychological, sociological, political, economic, and cultural aspects of trauma and its consequences on people around the world. Dispelling the myth that trauma-related dissociative disorders are a North American phenomenon, this unique book travels through more than a dozen countries to analyze the effects of long-lasting traumatization-both natural and man-made-on adults and children.

Trauma and Dissociation in China – Zeping Xiao, M.D., Heqin Yan, Zhen Wang, M.D., Zheng Zou, M.D., Yong Xu, M.D., Jue Chen, M.D., Haiyin Zhang, M.D., Colin A. Ross, M.D., and Benjamin B. Keyes, Ph.D. Am J Psychiatry 163:1388-1391, August 2006 doi: 10.1176/appi.ajp.163.8.1388 American Psychiatric Association

OBJECTIVE: In order to determine whether pathological dissociation occurs in China, the authors conducted a survey among psychiatric inpatients, outpatients, and the general population in Shanghai, China. There is virtually no popular or professional knowledge of dissociative identity disorder in China, and therefore professional and popular contamination cannot exist….

RESULTS: Dissociative disorders were diagnosed in 24 respondents by structured interview, and 15 respondents fell into the dissociative taxon on the Dissociative Experiences Scale. The outpatients reported the highest rates of childhood physical and/or sexual abuse and of pathological dissociation. CONCLUSIONS: Pathological dissociation can be detected readily among psychiatric outpatients in China but is much less common in the general population. Pathological dissociation is more frequent in more traumatized subsamples of the Chinese population. The findings are not consistent with the sociocognitive, contamination, or iatrogenic models of dissociative identity disorder.


Trauma and Dissociation in China – Zeping Xiao, M.D., Heqin Yan, Zhen Wang, M.D., Zheng Zou, M.D., Yong Xu, M.D., Jue Chen, M.D., Haiyin Zhang, M.D., Colin A. Ross, M.D., and Benjamin B. Keyes, Ph.D. Am J Psychiatry 163:1388-1391, August 2006 doi: 10.1176/appi.ajp.163.8.1388
2006 American Psychiatric Association

“China is a country in which there is little public or cultural awareness of dissociative identity disorder or other forms of chronic, complex, pathological dissociation. We are not familiar with any representation of the disorder on television, in film, in novels or plays, or in popular folklore. The trauma model of dissociation is not taught at medical schools in China, and dissociative disorders are very rarely diagnosed by mental health professionals. China, therefore, is virtually free of cultural or professional contamination concerning dissociative disorders.”
“The results of our study support the epidemiological prediction of the trauma model of dissociation and are not consistent with the sociocognitive model. Pathological dissociation was reported by Chinese respondents, despite the lack of contamination, role demands, and iatrogenic suggestion in China.”

“As shown in Table 1, there are hints in the secondary features of dissociative identity disorder that full or partial forms of dissociative identity disorder could affect more than 2.3% of the Chinese outpatient sample (the sum of the frequencies of these two diagnoses on the Dissociative Disorders Interview Schedule). For instance, 3.6% of the Chinese outpatients said that they have another person inside of them. The outpatients reported more childhood trauma than the other two groups. The outpatients had more dissociative disorders on the Dissociative Disorders Interview Schedule, more members of the dissociative taxon on the Dissociative Experiences Scale, higher average scores on the Dissociative Experiences Scale, and more secondary features of dissociative identity disorder on the Dissociative Disorders Interview Schedule. Thus, the outpatients were more dissociative than the other two groups on four different ways of assessing dissociation. The fact that they also reported more childhood abuse is consistent with the trauma model of pathological dissociation.”

“China provides an example of a culture largely uncontaminated by popular or professional knowledge of dissociative identity disorder and therefore is suitable for testing the epidemiological predictions of the trauma and sociocognitive models.”

full text at http://ajp.psychiatryonline.org/cgi/reprint/163/8/1388.pdf

Frequency of dissociative identity disorder in the general population in Turkey  Gamze Akyüz et al Comprehensive Psychiatry Volume 40, Issue 2, March-April 1999, Pages 151-159

This study attempted to determine the prevalence of dissociative identity disorder in the general population. The Dissociative Experiences Scale (DES) was administered to 994 subjects in 500 homes who constituted a representative sample of the population of Sivas City, Turkey….

Seventeen subjects (1.7%) received a diagnosis of dissociative disorder according to the structured interview. In the third phase, eight of 17 subjects who had a dissociative disorder on the structured interview could be contacted for a clinical evaluation. They were matched with a nondissociative control group and interviewed by a clinician blind to the structured interview diagnosis.

Four of eight subjects were diagnosed clinically with dissociative identity disorder, yielding a minimum prevalence of 0.4%. Dissociative identity disorder is not rare in the general population. Self-rating instruments and structured interviews can be used successfully for screening these cases.

Our data, derived from a population with no public awareness about dissociative identity disorder and no exposure to systematic psychotherapy, suggest that dissociative identity disorder cannot be considered simply an iatrogenic artifact, a culture-bound syndrome, or a phenomenon induced by media influences.

Fact or Factitious? A Psychobiological Study of Authentic and Simulated Dissociative Identity States (2012) A. A. T. Simone Reinders, Antoon T. M. Willemsen, Herry P. J. Vos, Johan A. den Boer, Ellert R. S. Nijenhuis PLoS  ONE 7(6): e39279. doi:10.1371/  journal.pone.0039279

“Methodology/Principal Findings
DID patients, high fantasy prone and low fantasy prone controls were studied in two different types of identity states (neutral and trauma-related) in an autobiographical memory script-driven (neutral or trauma-related) imagery paradigm. The controls were instructed to enact the two DID identity states. Twenty-nine subjects participated in the study: 11 patients with DID, 10 high fantasy prone DID simulating controls, and 8 low fantasy prone DID simulating controls. Autonomic and subjective reactions were obtained. Differences in psychophysiological and neural activation patterns were found between the DID patients and both high and low fantasy prone controls. That is, the identity states in DID were not convincingly enacted by DID simulating controls. Thus, important differences regarding regional cerebral bloodflow and psychophysiological responses for different types of identity states in patients with DID were upheld after controlling for DID simulation.

The findings are at odds with the idea that differences among different types of dissociative identity states in DID can be explained by high fantasy proneness, motivated role-enactment, and suggestion. They indicate that DID does not have a sociocultural (e.g., iatrogenic) origin. For the first time, it is shown using brain imaging that neither high nor low fantasy prone healthy women, who enacted two different types of dissociative identity states, were able to substantially simulate these identity states in psychobiological terms. These results do  not support the idea of a sociogenic origin for DID.http://www.plosone.org/article/info:doi/10.1371/journal.pone.0039279

Psychobiological characteristics of dissociative identity disorder: a symptom provocation study. Reinders AA, Nijenhuis ER, Quak J, Korf J, Haaksma J, Paans AM, Willemsen AT, den Boer JA. Biol Psychiatry. 2006 Oct 1;60(7):730-40.

Dissociative identity disorder (DID) patients function as two or more identities or dissociative identity states (DIS), categorized as ‘neutral identity states’ (NIS) and ‘traumatic identity states’ (TIS). NIS inhibit access to traumatic memories thereby enabling daily life functioning. TIS have access and responses to these memories. We tested whether these DIS show different psychobiological reactions to trauma-related memory.

A symptom provocation paradigm with 11 DID patients was used in a two-by-two factorial design setting. Both NIS and TIS were exposed to a neutral and a trauma-related memory script. Three psychobiological parameters were tested: subjective ratings (emotional and sensori-motor), cardiovascular responses (heart rate, blood pressure, heart rate variability) and regional cerebral blood flow as determined with H(2)(15)O positron emission tomography.

Psychobiological differences were found for the different DIS. Subjective and cardiovascular reactions revealed significant main and interactions effects. Regional cerebral blood flow data revealed different neural networks to be associated with different processing of the neutral and trauma-related memory script by NIS and TIS.

Patients with DID encompass at least two different DIS. These identities involve different subjective reactions, cardiovascular responses and cerebral activation patterns to a trauma-related memory script.

One Brain, Two Selves.  Reinders AA, Nijenhuis ER, Paans AM, Korf J, Willemsen AT, den Boer JA. Neuroimage. 2003 Dec;20(4):2119-25.

ABSTRACT:  Having a sense of self is an explicit and high-level functional specialization of the human brain. The anatomical localization of self-awareness and the brain mechanisms involved in consciousness were investigated by functional neuroimaging different emotional mental states of core consciousness in patients with Multiple Personality Disorder (i.e., Dissociative Identity Disorder (DID)). We demonstrate specific changes in localized brain activity consistent with their ability to generate at least two distinct mental states of self-awareness, each with its own access to autobiographical trauma-related memory. Our findings reveal the existence of different regional cerebral blood flow patterns for different senses of self. We present evidence for the medial prefrontal cortex (MPFC) and the posterior associative cortices to have an integral role in conscious experience.  http://www.ncbi.nlm.nih.gov/pubmed/14683715

Scientists Are Beginning to Understand What Causes Multiple Personality Disorder –  Makini Brice | July 02, 2012

“Researchers at King’s College London sought to find a clearer picture of the answer to that question. They studied 29 people, 11 had dissociative identity disorder, 10 were people who were highly prone to fantasy and 8 people were not very prone to fantasy, as a control. Of those without DID, they were made to simulate the symptoms of dissociative identity disorder. The researchers measured subjects’ brain activity, cardiovascular system, and their reactions.”

“They found that there were strong differences, both in regional blood flow and in reactions, between the DID sufferers and the control subjects. Researchers believe that indicates that DID sufferers do not merely have overactive imaginations, and that the origins of their ailment stem more likely from trauma.”