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128-545: Dissociative identity disorder ( DID ), previously known as multiple personality disorder ( MPD ), is one of multiple dissociative disorders in the DSM-5 , ICD-11 , and Merck Manual . It has a history of extreme controversy. Dissociative identity disorder is characterized by the presence of at least two distinct and relatively enduring personality states . The disorder is accompanied by memory gaps more severe than could be explained by ordinary forgetfulness. According to

256-498: A memory disorder , which was characterized by sudden retrograde episodic memory loss, said to occur for a period of time ranging from hours to years to decades. The atypical clinical syndrome of the memory disorder (as opposed to organic amnesia ) is that a person with psychogenic amnesia is profoundly unable to remember personal information about themselves; there is a lack of conscious self-knowledge which affects even simple self-knowledge, such as who they are. Psychogenic amnesia

384-574: A "wastebasket" diagnosis when organic amnesia is not apparent. Other researchers have hastened to defend the notion of psychogenic amnesia and its right not to be dismissed as a clinical disorder. Diagnoses of psychogenic amnesia have dropped since agreement in the field of transient global amnesia , suggesting some over diagnosis at least. Speculation also exists about psychogenic amnesia due to its similarities with 'pure retrograde amnesia', as both share similar retrograde loss of memory. Also, although no functional damage or brain lesions are evident in

512-462: A Western cultural context. For non-Western cultures dissociation "may constitute a "normal" psychological capacity". An alternative model proposes a perspective on dissociation based on a recently established link between a labile sleep–wake cycle and memory errors, cognitive failures, problems in attentional control, and difficulties in distinguishing fantasy from reality." Debates around DD also stem from Western versus non-Western lenses of viewing

640-465: A causal link. In addition, studies rarely control for the many disorders comorbid with dissociative identity disorder , or family maladjustment (which is itself highly correlated with dissociative identity disorder). The popular association of dissociative identity disorder with childhood abuse is relatively recent, occurring only after the publication of Sybil in 1973. Most previous examples of "multiples" such as Chris Costner Sizemore , whose life

768-413: A cause or the sociocognitive hypothesis as they believe it is a culture-bound and often health care induced condition. The social cues involved in diagnosis may be instrumental in shaping patient behavior or attribution, such that symptoms within one context may be linked to DID, while in another time or place the diagnosis could have been something other than DID. Other researchers disagree and argue that

896-463: A disproportionate number of cases would provide evidence for their position though it has also been claimed that higher rates of diagnosis in specific countries like the United States may be due to greater awareness of DID. Lower rates in other countries may be due to artificially low recognition of the diagnosis. However, false memory syndrome per se is not regarded by mental health experts as

1024-443: A few days and often report that after a week or two of recovering their body weight and attending group therapy tied to their eating disorder, the ideas and preoccupations with their "alters" gradually vanished from their thinking. McHugh believes that proponents of Dissociative Identity Disorder inadvertently worsen patient condition by validating the behavior and providing attention during the displays. The International Society for

1152-954: A follow-up of ten years. Adult and child treatment guidelines exist that suggest a three-phased approach. Common treatment methods include an eclectic mix of psychotherapy techniques, including cognitive behavioral therapy (CBT), insight-oriented therapy , dialectical behavioral therapy (DBT), hypnotherapy , and eye movement desensitization and reprocessing (EMDR). Hypnosis should be carefully considered when choosing both treatment and provider practitioners because of its dangers. For example, hypnosis can sometimes lead to false memories and false accusations of abuse by family, loved ones, friends, providers, and community members. Those who suffer from dissociative identity disorder have commonly been subject to actual abuse (sexual, physical, emotional, financial) by therapists, family, friends, loved ones, and community members. Some behavior therapists initially use behavioral treatments such as only responding to

1280-508: A form of coping as well as lack of developmental integration in childhood. Possibly due to developmental changes and a more coherent sense of self past age 6–9 years, the experience of extreme trauma may result in different, though also complex, dissociative symptoms, identity disturbances and trauma-related disorders. Relationships between childhood abuse, disorganized attachment , and lack of social support are thought to be common risk factors leading to dissociative identity disorder. Although

1408-411: A high rate of auditory hallucinations in the form of voices. Other disorders that have been found to be comorbid with DID are somatization disorders, major depressive disorder , as well as history of a past suicide attempt, in comparison to those without a DID diagnosis. 70–75% of DID patients attempt suicide, and multiple attempts are common. Disturbed and altered sleep has also been suggested as having

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1536-554: A history of such changes can help distinguish DID from other conditions. A diagnosis of DID takes precedence over any other dissociative disorders. Distinguishing DID from malingering is a concern when financial or legal gains are an issue, and factitious disorder may also be considered if the person has a history of help or attention-seeking. Individuals who state that their symptoms are due to external spirits or entities entering their bodies are generally diagnosed with dissociative disorder not otherwise specified rather than DID due to

1664-489: A lifelong course. Lifetime prevalence was found to be 1.1–1.5% of the general population (based on multiple epidemiological studies) and 3.9% of those admitted to psychiatric hospitals in Europe and North America. DID is diagnosed 6–9 times more often in women than in men, particularly in adult clinical settings; pediatric settings have nearly 1:1 ratio of girls to boys. The number of recorded cases increased significantly in

1792-466: A loved one or loved ones, human trafficking , and dysfunctional family dynamics. There is no medication to treat DID directly. However, medications can be used for comorbid disorders or targeted symptom relief; for example, antidepressants for anxiety and depression, or sedative-hypnotics to improve sleep. Treatment generally involves supportive care and psychotherapy . The condition generally does not remit without treatment, and many patients have

1920-478: A major risk factor for dissociative identity disorder." Other risk factors reported include painful medical procedures, war, terrorism, or being trafficked in childhood. Dissociative disorders frequently occur after trauma, and the DSM-5-TR places them after the chapter on trauma- and stressor-related disorders to reflect this close relationship between complex trauma and dissociation. Dissociative identity disorder

2048-443: A physiological basis, in that it involves automatically triggered mechanisms such as increased blood pressure and alertness, that would, as Lynn contends, imply its existence as a cross-species disorder. A second area of discussion surrounds the question of whether there is a qualitative or quantitative difference between dissociation as a defense versus pathological dissociation. Experiences and symptoms of dissociation can range from

2176-508: A reason to doubt the validity of the disorder, and proponents of both etiologies believe that the discovery of dissociative identity disorder in a child who had never undergone treatment would critically undermine the non-trauma related model. Conversely, if children are found to develop dissociative identity disorder only after undergoing treatment it would challenge the trauma-related model. As of 2011, approximately 250 cases of dissociative identity disorder in children have been identified, though

2304-568: A recent western Chinese study showed an increase in awareness of dissociative disorders present in children. These studies show that DD's have an intricate relationship with the patient's mental, physical and socio-cultural environments. This study suggested that dissociative disorders are more common in Western, or developing countries, however, some cases have been seen in both clinical and non-clinical Chinese populations. There are several reasons why recognizing symptoms of dissociation in children

2432-691: A role in dissociative disorders in general and specifically in DID, alterations in environments also largely affecting the DID patient. Individuals diagnosed with DID demonstrate the highest hypnotizability of any clinical population. Although DID has high comorbidity and its development is related to trauma, abundant empirical evidence suggests that DID is a separate condition from other disorders like PTSD. There are two competing theories on what causes dissociative identity disorder to develop. The trauma-related model suggests that complex trauma or severe adversity in childhood, also known as developmental trauma, increases

2560-464: A single identity, and then use more traditional therapy once a consistent response is established. Brief treatment due to managed care may be difficult, as individuals diagnosed with DID may have unusual difficulties in trusting a therapist and take a prolonged period to form a comfortable therapeutic alliance . Regular contact (at least weekly) is recommended, and treatment generally lasts years – not weeks or months. Sleep hygiene has been suggested as

2688-733: A single session and it is common for patients diagnosed with a dissociative disorder to not have a previous dissociative disorder diagnosis due to a lack of clinician training. Some diagnostic tests have also been adapted or developed for use with children and adolescents such as the Adolescent Dissociative Experiences Scale, Children's Version of the Response Evaluation Measure (REM-Y-71), Child Interview for Subjective Dissociative Experiences, Child Dissociative Checklist (CDC), Child Behavior Checklist (CBCL) Dissociation Subscale, and

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2816-665: A small number of clinicians who specialize in DID are responsible for the creation of alters through therapy. The condition may be under-diagnosed due to skepticism and lack of awareness from mental health professionals, made difficult due to the lack of specific and reliable criteria for diagnosing DID as well as a lack of prevalence rates due to the failure to examine systematically selected and representative populations. Patients with DID are diagnosed with 5–7 comorbid disorders on average – higher than other mental conditions. Misdiagnoses (e.g. schizophrenia, bipolar disorder) are very common among patients with DID. Due to overlapping symptoms,

2944-406: A small subset of doctors are responsible for diagnosing the majority of individuals with dissociative identity disorder. Psychologist Nicholas Spanos and others have suggested that in addition to therapy-caused cases, dissociative identity disorder may be the result of role-playing , though others disagree, pointing to a lack of incentive to manufacture or maintain separate identities and point to

3072-653: A substrate of borderline traits". Reviews of DID patients and their medical records concluded that 30–70% of those diagnosed with DID have comorbid borderline personality disorder . The DSM-5 elaborates on cultural background as an influence for some presentations of DID. Many features of dissociative identity disorder can be influenced by the individual's cultural background. Individuals with this disorder may present with prominent medically unexplained neurological symptoms, such as non-epileptic seizures, paralyses, or sensory loss, in cultural settings where such symptoms are common. Similarly, in settings where normative possession

3200-531: A symptom also found in dissociative identity disorder. No studies have looked for children with dissociative identity disorder in the general population, and the single study that attempted to look for children with dissociative identity disorder not already in therapy did so by examining siblings of those already in therapy for dissociative identity disorder. An analysis of diagnosis of children reported in scientific publications, 44 case studies of single patients were found to be evenly distributed (i.e., each case study

3328-559: A treatment option, but has not been tested. In general there are very few clinical trials on the treatment of DID, none of which were randomized controlled trials . Dissociative disorder Dissociative disorders ( DDs ) are a range of conditions characterized by significant disruptions or fragmentation "in the normal integration of consciousness, memory, identity, emotion, perception, body representation, motor control, and behavior." Dissociative disorders involve involuntary dissociation as an unconscious defense mechanism , wherein

3456-496: A valid diagnosis, and has been described as "a non-psychological term originated by a private foundation whose stated purpose is to support accused parents," and critics argue that the concept has no empirical support, and further describe the False Memory Syndrome Foundation as an advocacy group that has distorted and misrepresented memory research. The rarity of DID diagnoses in children is cited as

3584-750: A variety of disorders including mood disorders , psychosis , anxiety disorders , PTSD, personality disorders , cognitive disorders , neurological disorders , epilepsy , somatoform disorder , factitious disorder , malingering , other dissociative disorders, and trance states. An additional aspect of the controversy of diagnosis is that there are many forms of dissociation and memory lapses, which can be common in both stressful and nonstressful situations and can be attributed to much less controversial diagnoses. A relationship between DID and borderline personality disorder has been posited, with various clinicians noting overlap between symptoms and behaviors and it has been suggested that some cases of DID may arise "from

3712-490: A wide range of cases there is little consensus of which memory deficits are specific to psychogenic amnesia. Past literature has suggested psychogenic amnesia can be 'situation-specific' or 'global-transient', the former referring to memory loss for a particular incident, and the latter relating to large retrograde amnesic gaps of up to many years in personal identity. The most commonly cited examples of global-transient psychogenic amnesia are ' fugue states ', of which there

3840-611: Is depression (90%) that is often treatment-resistant, with headaches and non-epileptic seizures being common neurologic symptoms. Comorbid disorders include post-traumatic stress disorder (PTSD), substance use disorders , eating disorders , anxiety disorders , personality disorders , and autism spectrum disorder . 30–70% of those diagnosed with DID have history of borderline personality disorder . Presentations of dissociation in people with schizophrenia differ from those with DID as not being rooted in trauma, and this distinction can be effectively tested, although both conditions share

3968-462: Is a correlation between depersonalization-derealization disorder and childhood trauma, especially emotional abuse or neglect. It can also be caused by other forms of stress such as sudden death of a loved one. Treatment: Same treatment as dissociative amnesia. An episode of depersonalization-derealization disorder can be as brief as a few seconds or continue for several years. Dissociative disorders are characterized by distinct brain differences in

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4096-526: Is a sudden retrograde loss of autobiographical memory resulting in impairment of personal identity and usually accompanied by a period of wandering. Suspected cases of psychogenic amnesia have been heavily reported throughout the literature since 1935 where it was reported by Abeles and Schilder. There are many clinical anecdotes of psychogenic or dissociative amnesia attributed to stressors ranging from cases of child sexual abuse to soldiers returning from combat. The neurological cause of psychogenic amnesia

4224-520: Is a survival mechanism that often goes unnoticed in children that have been traumatised. Dr. Shoshanah Lyons suggests that traumatised children often continue to dissociate even though they might not be in any danger, and that they are often unaware that they are dissociating. In addition to developing diagnostic tests for children and adolescents (see above), a number of approaches have been developed to improve recognition and understanding of dissociation in children. Recent research has focused on clarifying

4352-509: Is accompanied by genuine suffering and the distressing symptoms, and can be diagnosed reliably using the DSM criteria, they are skeptical of the trauma-related etiology suggested by proponents of the trauma-related model. Proponents of non-trauma-related dissociative identity disorder are concerned about the possibility of hypnotizability, suggestibility, frequent fantasization and mental absorption predisposing individuals to dissociation. They note that

4480-468: Is an organic response to trauma, but believe it is a socially constructed behavior and psychic contagion. McHugh says that the disorder is "sustained in large part by the attention that doctors tend to pay to it. This means that it is not a mental condition that derives from nature, such as panic anxiety or major depression. It exists in the world as an artificial product of human devising". According to McHugh, at Johns Hopkins Hospital doctors should ignore

4608-459: Is associated with learning and the formation of memory, and its reduced volume is associated with impairments in memory for those with DID and PTSD. Brain-imaging studies demonstrating the link between reduced hippocampal volume and DID as well as PTSD have added to empirical support for the existence of the disorder, as additional brain-imaging studies have demonstrated a negative correlation between hippocampal volume and early childhood trauma (which

4736-452: Is challenging: it may be difficult for children to describe their internal experiences; caregivers may miss signals or attempt to conceal their own abusive or neglectful behaviors; symptoms can be subtle or fleeting; disturbances of memory, mood, or concentration associated with dissociation may be misinterpreted as symptoms of other disorders. Another resource, Beacon House, informs us of dissociative disorder in children, suggesting that it

4864-675: Is characterized by intense disagreement. Research into this hypothesis has been characterized by poor methodology . Psychiatrist Joel Paris notes that the idea that a personality is capable of splitting into independent alters is an unproven assertion that is at odds with research in cognitive psychology . Some people, such as Russell A. Powell and Travis L. Gee, believe that DID is caused by health care, i.e. symptoms of DID are created by therapists themselves via hypnosis. This belief also implies that those with DID are more susceptible to manipulation by hypnosis and suggestion than others. The iatrogenic model also sometimes states that treatment for DID

4992-586: Is common (e.g., rural areas in the developing world, among certain religious groups in the United States and Europe), the fragmented identities may take the form of possessing spirits, deities, demons, animals, or mythical figures. Acculturation or prolonged intercultural contact may shape the characteristics of other identities (e.g., identities in India may speak English exclusively and wear Western clothes). Possession-form dissociative identity disorder can be distinguished from culturally accepted possession states in that

5120-486: Is commonly comorbid with dissociative identity disorder. In addition, presentations can vary across cultures, such as Indian patients who only switch alters after a period of sleep – which is commonly how dissociative identity disorder is presented by the media within that country. Proponents of non-trauma-related dissociative identity disorder state that the disorder is strongly linked to (possibly suggestive) psychotherapy, often involving recovered memories (memories that

5248-518: Is controversial as causation is not always clear, and both elements of psychological stress and organic amnesia may be present among cases. Often, but not necessarily, a premorbid history of psychiatric illness such as depression is thought to be present in conjunction to triggers of psychological stress. Lack of psychological evidence precipitating amnesia does not mean there is not any, for example trauma during childhood has even been cited as triggering amnesia later in life, but such an argument runs

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5376-450: Is controversial. Even in cases of organic amnesia, where there is lesion or structural damage to the brain, caution must still be taken in defining causation, as only damage to areas of the brain crucial to memory processing is possible to result in memory impairment . Organic causes of amnesia can be difficult to detect, and often both organic cause and psychological triggers can be entangled. Failure to find an organic cause may result in

5504-559: Is distinguished from organic amnesia in that it is supposed to result from a nonorganic cause: no structural brain damage should be evident but some form of psychological stress should precipitate the amnesia. Psychogenic amnesia as a memory disorder is controversial. Psychogenic amnesia is the presence of retrograde amnesia (the inability to retrieve stored memories leading up to the onset of amnesia), and an absence of anterograde amnesia (the inability to form new long term memories). Access to episodic memory can be impeded, while

5632-435: Is enhanced by media portrayals of dissociative identity disorder. Proponents of the non-trauma-related model note that the dissociative symptoms are rarely present before intensive therapy by specialists in the treatment of dissociative identity disorder who, through the process of eliciting, conversing with, and identifying alters, shape or possibly create the diagnosis. While proponents note that dissociative identity disorder

5760-560: Is generally a childhood-onset disorder. According to the fifth edition [text revision] of the Diagnostic and Statistical Manual of Mental Disorders ( DSM-5-TR ), symptoms of DID include "the presence of two or more distinct personality states" accompanied by the inability to recall personal information beyond what is expected through normal memory issues. Other DSM-5 symptoms include a loss of identity as related to individual distinct personality states, loss of one's subjective experience of

5888-511: Is harmful. According to Brand, Loewenstein, and Spiegel, "[t]he claims that DID treatment is harmful are based on anecdotal cases, opinion pieces, reports of damage that are not substantiated in the scientific literature, misrepresentations of the data, and misunderstandings about DID treatment and the phenomenology of DID". Their claim is evidenced by the fact that only 5%–10% of people receiving treatment initially worsen in their symptoms. Psychiatrists August Piper and Harold Merskey have challenged

6016-413: Is hypothesized to be a potential etiological factor for dissociative symptoms). There are no medications to cure or completely treat dissociative disorders, however, drugs to treat anxiety and depression that may accompany the disorders can be given. The lifetime prevalence of dissociative disorders varies from 10% in the general population to 46% in psychiatric inpatients. Diagnosis can be made with

6144-514: Is increasing that dissociative disorders are related both to a trauma history and to "specific neural mechanisms". It has also been suggested that there may be a genuine but more modest link between trauma and dissociative identity disorder, with early trauma causing increased fantasy -proneness, which may in turn render individuals more vulnerable to socio-cognitive influences surrounding the development of dissociative identity disorder. Another suggestion made by Hart indicates that there are triggers in

6272-457: Is known by another. Individuals with DID may be reluctant to discuss symptoms due to associations with abuse, shame, and fear. DID patients may also frequently and intensely experience time disturbances, both from amnesia and derealization. Around half of people with DID have fewer than 10 identities and most have fewer than 100; although as many as 4,500 have been reported by Richard Kluft in 1988. The average number of identities has increased over

6400-636: Is not completely understood due to the many difficulties in diagnosing dissociative disorders. Many of these difficulties stem from a misunderstanding of dissociative disorders, from an unfamiliarity diagnosis or symptoms to disbelief in some dissociative disorders entirely. Due to this it has been found that only 28% to 48% of people diagnosed with a dissociative disorder receive treatment for their mental health. Patients who are misdiagnosed are often those more likely to be hospitalised repeatedly, and lack of treatment can result in intensive outpatient treatment and higher rates of disability. An important concern in

6528-646: Is not present, and it is highly likely that both psychological factors and organic cause exist in pure retrograde amnesia. Psychogenic amnesia is supposed to differ from organic amnesia in a number of ways; one being that unlike organic amnesia, psychogenic amnesia is thought to occur when no structural damage to the brain or brain lesion is evident. Psychological triggers are instead considered as preceding psychogenic amnesia, and indeed many anecdotal case studies which are cited as evidence of psychogenic amnesia hail from traumatic experiences such as World War II. As aforementioned however, an etiology of psychogenic amnesia

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6656-453: Is often conceptualized as "the most severe form of a childhood-onset post-traumatic stress disorder." According to many researchers, the etiology of dissociative identity is multifactorial, involving a complex interaction between developmental trauma, sociocultural influences, and biological factors. People diagnosed with dissociative identity disorder often report that they have experienced physical or sexual abuse during childhood (although

6784-410: Is required to establish whether a young patient's recovery will remain stable over time. A number of aspects of dissociative disorders are currently in active debate. First, there is ongoing debate surrounding the etiology of dissociative identity disorder (DID). The crux of this debate is if DID is the result of childhood trauma or disorganized attachment. A proposed view is that dissociation has

6912-664: Is said to be steepest at its most recent premorbid period, whereas for psychogenic amnesia the temporal gradient of retrograde autobiographical memory loss is said to be quite consistently flat. Although there is much literature on psychogenic amnesia as dissimilar to organic amnesia, the distinction between neurological and psychological features is often difficult to discern and remains controversial. Brain activity can be assessed functionally for psychogenic amnesia using imaging techniques such as fMRI , PET and EEG , in accordance with clinical data. Some research has suggested that organic and psychogenic amnesia to some extent share

7040-409: Is supposed to differ from organic amnesia qualitatively in that retrograde loss of autobiographical memory while semantic memory remains intact is said to be specific of psychogenic amnesia. Another difference that has been cited between organic and psychogenic amnesia is the temporal gradient of retrograde loss of autobiographical memory. The temporal gradient of loss in most cases of organic amnesia

7168-449: Is thought to be a coping mechanism employed in extremely threatening or traumatic events. By inhibiting structures in the limbic system, such as the amygdala , the brain is able to reduce extreme levels of arousal. In the dissociative subtype of PTSD, there is both excessive control of emotions through suppressed limbic structures and insufficient control of emotions in the hyperactivity of the medial prefrontal cortex. Increased activity in

7296-470: Is unrelated to abuse, such as war or the death of a loved one. Dissociative disorders, especially dissociative identity disorder (DID), should not be treated with an extraordinary or supernatural status. DDs would be better examined and treated through the lens of any other psychological disorder. Cause: The cause of dissociative identity disorder is contentious; it is most often considered to be caused either by ongoing childhood trauma that occurs before

7424-656: The American Psychiatric Association 's Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5) are as follows: The ICD-11 lists dissociative disorders as: Dissociative disorders most often develop as a way to cope with psychological trauma. People with dissociative disorders were commonly subjected to chronic physical, sexual, or emotional abuse as children (or, less frequently, an otherwise frightening or highly unpredictable home environment). Some categories of DD, however, can form due to trauma that occurs later in life and

7552-503: The American Psychiatric Association 's Diagnostic and Statistical Manual of Mental Disorders (DSM-5-TR) diagnoses DID according to the diagnostic criteria found under code 300.14 (dissociative disorders) . DID is often initially misdiagnosed because clinicians receive little training about dissociative disorders or DID, and often use standard diagnostic interviews that do not include questions about trauma, dissociation, or post-traumatic symptoms. This contributes to difficulties diagnosing

7680-497: The COVID-19 pandemic , coinciding with an increase in social media content related to[…]dissociative identity disorder." The paper concluded by saying there "is an urgent need for focused empirical research investigation into this concerning phenomenon that is related to the broader research and discourse examining social media influences on mental health". Proponents of the sociogenic model dispute that dissociative identity disorder

7808-685: The Dissociative Experiences Scale , Dissociative Disorders Interview Schedule and Structured Clinical Interview for Dissociative Disorders) that are in the internal validity range of widely accepted mental illnesses such as schizophrenia and major depressive disorder . In his opinion, Piper and Merskey are setting the standard of proof higher than they are for other diagnoses. He also asserts that Piper and Merskey have cherry-picked data and not incorporated all relevant scientific literature available, such as independent corroborating evidence of trauma. A paper published in 2022 in

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7936-407: The medial prefrontal cortex is associated with non-dissociative symptoms such as re-experiencing and hyperarousal. There are notable differences in the volume of certain areas of the brain such as reduced cortical and subcortical volumes in the hippocampus and amygdala. Reduced volume of the amygdala may account for the lessened emotional reactivity observed during dissociation. The hippocampus

8064-646: The DSM and undefined concepts such as "personality state" and "identities", and question the evidence for childhood abuse beyond self-reports, the lack of definition of what would indicate a threshold of abuse sufficient to induce DID and the extremely small number of cases of children diagnosed with DID despite an average age of appearance of the first alter of three years. Psychiatrist Colin Ross disagrees with Piper and Merskey's conclusion that DID cannot be accurately diagnosed, pointing to internal consistency between different structured dissociative disorder interviews (including

8192-566: The DSM-5-TR, early childhood trauma, typically starting before 5–6 years of age, places someone at risk of developing dissociative identity disorder. Across diverse geographic regions, 90% of individuals diagnosed with dissociative identity disorder report experiencing multiple forms of childhood abuse , such as rape, violence, neglect, or severe bullying. Other traumatic childhood experiences that have been reported include painful medical and surgical procedures, war, terrorism, attachment disturbance , natural disaster, cult and occult abuse, loss of

8320-411: The DSM-5-TR. The primary dispute is between those who believe DID is caused by traumatic stresses forcing the mind to split into multiple identities , each with a separate set of memories, and the belief that the symptoms of DID are produced artificially by certain psychotherapeutic practices or patients playing a role they believe appropriate for a person with DID. The debate between the two positions

8448-466: The Study of Trauma and Dissociation , proponents of the trauma model, have published guidelines for phase-oriented treatment in adults as well as children and adolescents that are widely used successfully in the field of DID treatment. The guidelines state that "a desirable treatment outcome is a workable form of integration or harmony among alternate identities". Some experts in treating people with DID use

8576-545: The Trauma Symptom Checklist for Children Dissociation Subscale. Dissociative disorders have been found to be quite prevalent in outpatient populations, as well as within low-income communities. One study found that in a population of poor inner-city outpatients, there was a 29% prevalence of dissociative disorders. There are problems with classification, diagnosis and therapeutic strategies of dissociative and conversion disorders which can be understood by

8704-553: The West and non-Western societies, there are aspects of each that show DD has universal characteristics. For example, while shamanic and rituals of non-Western societies may hold dissociative aspects, this is not exclusive as many Christian sects, such as "possession by the Holy Ghost" share similar qualities to those of non-Western trances. Dissociative amnesia Dissociative amnesia was previously known as psychogenic amnesia,

8832-453: The accuracy of these reports has been disputed); others report overwhelming stress, serious medical illness, or other traumatic events during childhood. They also report more historical psychological trauma than those diagnosed with any other mental illness. Severe sexual, physical, or psychological trauma in childhood has been proposed as an explanation for its development; awareness, memories, and emotions of harmful actions or events caused by

8960-446: The activation of various brain regions including the inferior parietal lobe , prefrontal cortex , and limbic system . Those with dissociative disorders have higher activity levels in the prefrontal lobe and a more inhibited limbic system on average than healthy controls. Heightened corticolimbic inhibition is associated with distinctly dissociative symptoms such as depersonalization and derealization. The function of these symptoms

9088-406: The aetiology of psychogenic amnesia is possible, which means cause and consequence can be infeasible to untangle. Because psychogenic amnesia is defined by its lack of physical damage to the brain, treatment by physical methods is difficult. Nonetheless, distinguishing between organic and dissociative memory loss has been described as an essential first-step in effective treatments. Treatments in

9216-597: The ages of six to nine, or as an unintentional product of therapy, fantasy , or other sociogenic factors. Treatment: Long-term psychotherapy to improve the patient's quality of life. Psychotherapy often involves hypnosis (to help a patient remember and work through the trauma), creative art therapy (using creative process to help a person who cannot express their thoughts), cognitive therapy (talk therapy to identify unhealthy and negative beliefs or behaviors), and medications (antidepressants, anti-anxiety medications, or sedatives). These medications can help control

9344-403: The amnesia, and drugs such as intravenously administered barbiturates (often thought of as ' truth serum ') were popular as treatment for psychogenic amnesia during World War II; benzodiazepines may have been substituted later. 'Truth serum' drugs were thought to work by making a painful memory more tolerable when expressed through relieving the strength of an emotion attached to a memory. Under

9472-406: The brain that can be the catalyst for different self-states, and that victims of trauma are more susceptible to these triggers than non-victims of trauma; these triggers are said to be related to dissociative identity disorder. Paris states that the trauma model of dissociative identity disorder increased the appeal of the diagnosis among health care providers, patients and the public as it validated

9600-417: The case of pure retrograde amnesia, unlike psychogenic amnesia it is not thought that purely psychological or 'psychogenic triggers' are relevant to pure retrograde amnesia. Psychological triggers such as emotional stress are common in everyday life, yet pure retrograde amnesia is considered very rare. Also the potential for organic damage to fall below threshold of being identified does not necessarily mean it

9728-482: The claimed histories of abuse. Other arguments that therapy can cause dissociative identity disorder include the lack of children diagnosed with DID, the sudden spike in rates of diagnosis after 1980 (although dissociative identity disorder was not a diagnosis until DSM-IV, published in 1994), the absence of evidence of increased rates of child abuse, the appearance of the disorder almost exclusively in individuals undergoing psychotherapy, particularly involving hypnosis ,

9856-417: The data does not offer unequivocal support for either theory. While children have been diagnosed with dissociative identity disorder before therapy, several were presented to clinicians by parents who were themselves diagnosed with dissociative identity disorder; others were influenced by the appearance of dissociative identity disorder in popular culture or due to a diagnosis of psychosis due to hearing voices –

9984-479: The degree of impairment to short term memory , semantic memory and procedural memory is thought to vary among cases. If other memory processes are affected, they are usually much less severely affected than retrograde autobiographical memory, which is taken as the hallmark of psychogenic amnesia. However the wide variability of memory impairment among cases of psychogenic amnesia raises questions as to its true neuropsychological criteria, as despite intense study of

10112-530: The diagnosis of dissociative disorders in forensic interviews is the possibility that the patient may be feigning symptoms in order to escape negative consequences. Young criminal offenders report much higher levels of dissociative disorders, such as amnesia. In one study it was found that 1% of young offenders reported complete amnesia for a violent crime, while 19% claimed partial amnesia. There have also been cases in which people with dissociative identity disorder provide conflicting testimonies in court, depending on

10240-404: The diagnosis that the amnesia is psychological, however it is possible that some organic causes may fall below a threshold of detection, while other neurological ails are thought to be unequivocally organic (such as a migraine ) even though no functional damage is evident. Possible malingering must also be taken into account. Some researchers have cautioned against psychogenic amnesia becoming

10368-436: The differential diagnosis includes schizophrenia , normal and rapid-cycling bipolar disorder , epilepsy , borderline personality disorder , and autism spectrum disorder . Delusions or auditory hallucinations can be mistaken for speech by other personalities. Persistence and consistency of identities and behavior, amnesia, measures of dissociation or hypnotizability and reports from family members or other associates indicating

10496-433: The disorder and related issues with a mental health provider. The medication pentothal can sometimes help to restore the memories. The length of an event of dissociative amnesia may be a few minutes or several years. If an episode is associated with a traumatic event, the amnesia may clear up when the person is removed from the traumatic situation. Cause: While not as strongly linked as other dissociative disorders, there

10624-433: The disorder, and associated views of causes of DD. DID was initially believed to be specific to the West, until cross-cultural studies indicated its occurrence worldwide. Conversely, anthropologists have largely done little work on DD in the West relating to its perceptions of possession syndromes that would be present in non-Western societies. While dissociation has been viewed and catalogued by anthropologists differently in

10752-469: The disorder, and to clinician bias. DID is rarely diagnosed in children, despite the average age of appearance of the first alter being three years old. The criteria require that an individual be recurrently controlled by two or more discrete identities or personality states, accompanied by memory lapses for important information that is not caused by alcohol, drugs or medications and other medical conditions such as complex partial seizures . In children

10880-401: The displays from "alters", and instead focus on treatment for other psychiatric problems patients present with. This method of treatment is reportedly successful: What surprises many people is that multiple personalities tend to fall away quickly when ignored. Usually on our anorexia nervosa floor, patients who entered with MPD [multiple personality disorder] cease discussing their alters within

11008-420: The evaluation as well. Since most of the symptoms depend on self-report and are not concrete and observable, there is a degree of subjectivity in making the diagnosis. People are often disinclined to seek treatment, especially since their symptoms may not be taken seriously; thus dissociative disorders have been referred to as "diseases of hiddenness". The diagnosis has been criticized by supporters of therapy as

11136-778: The exception of smaller hippocampal volume in DID patients. In addition, many of the studies that do exist were performed from an explicitly trauma-based position. There is no research to date regarding the neuroimaging and introduction of false memories in DID patients, though there is evidence of changes in visual parameters and support for amnesia between alters. DID patients also appear to show deficiencies in tests of conscious control of attention and memorization (which also showed signs of compartmentalization for implicit memory between alters but no such compartmentalization for verbal memory ) and increased and persistent vigilance and startle responses to sound. DID patients may also demonstrate altered neuroanatomy . The fifth, revised edition of

11264-414: The existence of evidence of linkages between trauma experienced in childhood and the capacity for dissociation or depersonalisation. They also suggest that individuals who are able to utilise dissociative techniques are able to keep this as an extended strategy to cope with stressful situations. Clinicians and researchers stress the importance of using a developmental model to understand both symptoms and

11392-502: The existence of the condition and its inclusion in the DSM is supported by multiple lines of reliable evidence, with diagnostic criteria allowing it to be clearly discriminated from conditions it is often mistaken for (schizophrenia, borderline personality disorder, and seizure disorder). That a large proportion of cases are diagnosed by specific health care providers, and that symptoms have been created in nonclinical research subjects given appropriate cueing has been suggested as evidence that

11520-401: The former is involuntary, distressing, uncontrollable, and often recurrent or persistent; involves conflict between the individual and his or her surrounding family, social, or work milieu; and is manifested at times and in places that violate the norms of the culture or religion. DID is among the most controversial of the dissociative disorders and among the most controversial disorders found in

11648-427: The future course of DDs. In other words, symptoms of dissociation may manifest differently at different stages of child and adolescent development and individuals may be more or less susceptible to developing dissociative symptoms at different ages. Further research into the manifestation of dissociative symptoms and vulnerability throughout development is needed. Related to this developmental approach, more research

11776-738: The help of structured clinical interviews such as the Dissociative Disorders Interview Schedule (DDIS) and the Structured Clinical Interview for DSM-IV Dissociative Disorders (SCID-D-R), and behavioral observation of dissociative signs during the interview. Additional information can be helpful in diagnosis, including the Dissociative Experiences Scale or other questionnaires, performance-based measures, records from doctors or academic records, and information from partners, parents, or friends. A dissociative disorder cannot be ruled out in

11904-791: The historic context of hysteria . Even current systems used to diagnose DD such as the DSM-IV and ICD-10 differ in the way the classification is determined. In most cases mental health professionals are still hesitant to diagnose patients with Dissociative Disorder, because before they are considered to be diagnosed with Dissociative Disorder these patients have more than likely been diagnosed with major depressive disorder , anxiety disorder , and most often post-traumatic stress disorder . It has been found from interviews with those who may be afflicted with dissociative disorders may be more effective at getting an accurate diagnosis than self-scoring assessments and scales. The prevalence of dissociative disorders

12032-557: The hypothesis that current or recent trauma may affect an individual's assessment of the more distant past, changing the experience of the past and resulting in dissociative states. However, experimental research in cognitive science continues to challenge claims concerning the validity of the dissociation construct, which is still based on Janetian notions of structural dissociation. Even the claimed etiological link between trauma/abuse and dissociation has been questioned. Links observed between trauma/abuse and DD are largely only present from

12160-516: The idea that child abuse had lifelong, serious effects. Paris asserts that there is very little experimental evidence supporting the trauma-dissociation hypothesis, and no research showing that dissociation consistently links to long-term memory disruption. Neuroimaging studies have reported a consistently smaller volume of the hippocampus in DID patients, supporting the trauma model. Symptoms of dissociative identity disorder may be created by therapists using techniques to "recover" memories (such as

12288-432: The individual with a dissociative disorder experiences separation in these areas as a means to protect against traumatic stress. Some dissociative disorders are caused by major psychological trauma , though the onset of depersonalization-derealization disorder may be preceded by less severe stress, by the influence of psychoactive substances , or occur without any discernible trigger. The dissociative disorders listed in

12416-456: The influence of these 'truth' drugs the patient would more readily talk about what had occurred to them. However, information elicited from patients under the influence of drugs such as barbiturates would be a mixture of truth and fantasy, and was thus not regarded as scientific in gathering accurate evidence for past events. Often treatment was aimed at treating the patient as a whole, and probably varied in practice in different places. Hypnosis

12544-446: The involvement of the same structures of the temporo-frontal region in the brain. It has been suggested that deficits in episodic memory may be attributable to dysfunction in the limbic system , while self-identity deficits have been suggested as attributable to functional changes related to the posterior parietal cortex . To reiterate however, care must be taken when attempting to define causation as only ad hoc reasoning about

12672-518: The journal Comprehensive Psychiatry described how prolonged social media use, especially on video-sharing platforms including TikTok , has exposed young people, largely adolescent females, a core user group of TikTok, to a growing number of content creators making videos about their self-diagnosed disorders. "An increasing number of reports from the US, UK, Germany, Canada, and Australia have noted an increase in functional tic-like behaviors prior to and during

12800-770: The lack of identities or personality states. Most individuals who enter an emergency department and are unaware of their names are generally in a psychotic state. Although auditory hallucinations are common in DID, complex visual hallucinations may also occur. Those with DID generally have adequate reality testing; they may have positive Schneiderian symptoms of schizophrenia but lack the negative symptoms. They perceive any voices heard as coming from inside their heads (patients with schizophrenia experience them as external). In addition, individuals with psychosis are much less susceptible to hypnosis than those with DID. Difficulties in differential diagnosis are increased in children. DID must be distinguished from, or determined if comorbid with,

12928-543: The latter half of the 20th century, along with the number of identities reported by those affected. However, it is unclear whether increased rates of diagnosis are due to better recognition or sociocultural factors such as mass media portrayals. The typical presenting symptoms in different regions of the world may also vary depending on culture, such as alter identities taking the form of possessing spirits, deities , ghosts, or mythical creatures in cultures where possession states are normative. Critics argue that dissociation ,

13056-514: The more distant past, changing the experience of the past and resulting in dissociative states. Giesbrecht et al. have suggested there is no actual empirical evidence linking early trauma to dissociation, and instead suggest that problems with neuropsychological functioning , such as increased distractibility in response to certain emotions and contexts, account for dissociative features. A middle position hypothesizes that trauma, in some situations, alters neuronal mechanisms related to memory. Evidence

13184-508: The more mundane to those associated with post traumatic stress disorder (PTSD) or acute stress disorder (ASD) to dissociative disorders. Mirroring this complexity, the DSM-5 workgroup considered grouping dissociative disorders with other trauma/stress disorders, but instead decided to put them in the following chapter to emphasize the close relationship. The DSM-5 also introduced a dissociative subtype of PTSD. A 2012 review article supports

13312-409: The neurological basis of symptoms associated with dissociation by studying neurochemical, functional and structural brain abnormalities that can result from childhood trauma. Others in the field have argued that recognizing disorganized attachment (DA) in children can help alert clinicians to the possibility of dissociative disorders. In their 2008 article, Rebecca Seligman and Laurence Kirmayer suggest

13440-412: The passage of time, and degradation of a sense of self and consciousness. In each individual, the clinical presentation varies and the level of functioning can change from severe impairment to minimal impairment. The symptoms of dissociative amnesia are subsumed under a DID diagnosis, and thus should not be diagnosed separately if DID criteria are met. Individuals with DID may experience distress from both

13568-449: The past few decades, from two or three to now an average of approximately 16. However, it is unclear whether this is due to an actual increase in identities, or simply that the psychiatric community has become more accepting of a high number of compartmentalized memory components. The psychiatric history frequently contains multiple previous diagnoses of various disorders and treatment failures. The most common presenting complaint of DID

13696-470: The past have attempted to alleve psychogenic amnesia by treating the mind itself, as guided by theories which range from notions such as 'betrayal theory' to account for memory loss attributed to protracted abuse by caregivers to the amnesia as a form of self-punishment in a Freudian sense, with the obliteration of personal identity as an alternative to suicide . Treatment attempts often have revolved around trying to discover what traumatic event had caused

13824-401: The person previously had amnesia for) or false memories , and that such therapy could cause additional identities. Such memories could be used to make an allegation of child sexual abuse . There is little agreement between those who see therapy as a cause and trauma as a cause. Supporters of therapy as a cause of dissociative identity disorder suggest that a small number of clinicians diagnosing

13952-418: The personality that is present. The world-wide prevalence of dissociative disorders is not well understood due to different cultural beliefs surrounding human emotions and the human brain. Dissociative disorders (DD) are widely believed to have roots in adverse childhood experiences including abuse and loss, but the symptoms often go unrecognized or are misdiagnosed in children and adolescents. However,

14080-484: The presences of bizarre alternate identities (such as those claiming to be animals or mythological creatures) and an increase in the number of alternate identities over time (as well as an initial increase in their number as psychotherapy begins in DID-oriented therapy). These various cultural and therapeutic causes occur within a context of pre-existing psychopathology, notably borderline personality disorder , which

14208-426: The range of mild to severe symptoms is a result of different etiologies and biological structures. Other terms used in the literature, including personality , personality state, identity , ego state, and amnesia , also have no agreed upon definitions. Multiple competing models exist that incorporate some non-dissociative symptoms while excluding dissociative ones. Due to the lack of consensus regarding terminology in

14336-422: The risk of psychogenic amnesia becoming an umbrella term for any amnesia of which there is no apparent organic cause. Due to organic amnesia often being difficult to detect, defining between organic and psychogenic amnesia is not easy and often context of precipitating experiences are considered (for example, if there has been drug abuse ) as well as the symptomology the patient presents with. Psychogenic amnesia

14464-441: The risk of someone developing dissociative identity disorder. The non-trauma related model, also referred to as the sociogenic or fantasy model, suggests that dissociative identity disorder is developed through high fantasy-proneness or suggestibility, roleplaying, or sociocultural influences. The DSM-5-TR states that "early life trauma (e.g., neglect and physical, sexual, and emotional abuse, usually before ages 5–6 years) represents

14592-461: The role of a child's biological capacity to dissociate remains unclear, some evidence indicates a neurobiological impact of developmental stress. Moreover, children are universally born un-integrated. Delinking early trauma from the etiology of dissociation has been explicitly rejected by those supporting the early trauma model. However, a 2012 review article supports the hypothesis that current or recent trauma may affect an individual's assessment of

14720-497: The study of DID, several terms have been proposed. One is ego state (behaviors and experiences possessing permeable boundaries with other such states but united by a common sense of self), while the other term is alters (each of which may have a separate autobiographical memory , independent initiative and a sense of ownership over individual behavior). The full presentation of dissociative identity disorder can onset at any age, although symptoms typically begin by ages 5–10. DID

14848-400: The symptoms associated with DID and other DD, but there are no medications yet that specifically treat dissociative disorders. Cause: Psychological trauma. While a history of child abuse is common in patients, it is not a necessary factor in determining if a person will develop dissociative amnesia. Treatment: Psychotherapy counseling or psychosocial therapy which involves talking about

14976-480: The symptoms must not be better explained by "imaginary playmates or other fantasy play". Diagnosis is normally performed by a clinically trained mental health professional such as a psychiatrist or psychologist through clinical evaluation, interviews with family and friends, and consideration of other ancillary material. Specially designed interviews (such as the SCID-D ) and personality assessment tools may be used in

15104-430: The symptoms of DID (hearing voices, intrusive thoughts/emotions/impulses) and the consequences of the accompanying symptoms (inability to remember specific information or periods of time). The large majority of patients with DID report repeated childhood sexual and/or physical abuse , usually by caregivers as well as organized abuse. Amnesia between identities may be asymmetrical; identities may or may not be aware of what

15232-467: The techniques recommended in the 2011 treatment guidelines. The empirical research includes the longitudinal TOP DD treatment study, which found that patients showed "statistically significant reductions in dissociation, PTSD, distress, depression, hospitalisations, suicide attempts, self-harm, dangerous behaviours, drug use, and physical pain" and improved overall functioning. Treatment effects have been studied for over thirty years, with some studies having

15360-407: The term that underlies dissociative disorders , lacks a precise, empirical, and generally agreed upon definition. A large number of diverse experiences have been termed dissociative, ranging from normal failures in attention to the breakdowns in memory processes characterized by the dissociative disorders. It is therefore unknown if there is a commonality between all dissociative experiences, or if

15488-481: The trauma are sequestered away from consciousness, and alternate parts form with differing memories, emotions, beliefs, temperament and behavior. Dissociative identity disorder is also attributed to extremes of stress and disturbances of attachment to caregivers in early life. What may result in complex post-traumatic stress disorder (PTSD) in adults may become dissociative identity disorder when occurring in children, possibly due to their greater use of imagination as

15616-421: The trauma hypothesis, arguing that correlation does not imply causation – the fact that people with DID report childhood trauma does not mean trauma causes DID – and point to the rareness of the diagnosis before 1980 as well as a failure to find DID as an outcome in longitudinal studies of traumatized children. They assert that DID cannot be accurately diagnosed because of vague and unclear diagnostic criteria in

15744-709: The trauma-related model claim the high correlation of child sexual and physical abuse reported by adults with dissociative identity disorder corroborates the link between trauma and dissociative identity disorder. However, the link between dissociative identity disorder and maltreatment has been questioned for several reasons. The studies reporting the links often rely on self-report rather than independent corroborations, and these results may be worsened by selection and referral bias. Most studies of trauma and dissociation are cross-sectional rather than longitudinal , which means researchers can not attribute causation , and studies avoiding recall bias have failed to corroborate such

15872-489: The use of hypnosis to "access" alter identities, facilitate age regression or retrieve memories) on suggestible individuals. Referred to as the non-trauma-related model, or the sociocognitive model or fantasy model, it proposes that dissociative identity disorder is due to a person consciously or unconsciously behaving in certain ways promoted by cultural stereotypes, with unwitting therapists providing cues through improper therapeutic techniques. This model posits that behavior

16000-562: Was also popular as a means for gaining information from people about their past experiences, but like 'truth' drugs really only served to lower the threshold of suggestibility so that the patient would speak easily but not necessarily truthfully. If no motive for the amnesia was immediately apparent, deeper motives were usually sought by questioning the patient more intensely, often in conjunction with hypnosis and 'truth' drugs. In many cases, however, patients were found to spontaneously recover from their amnesia on their own accord so no treatment

16128-408: Was depicted in the book and film The Three Faces of Eve , reported no memory of childhood trauma. Despite research on DID including structural and functional magnetic resonance imaging , positron emission tomography , single-photon emission computed tomography , event-related potentials , and electroencephalography , no convergent neuroimaging findings have been identified regarding DID, with

16256-440: Was reported by a different author) but in articles regarding groups of patients, four researchers were responsible for the majority of the reports. The initial theoretical description of dissociative identity disorder was that dissociative symptoms were a means of coping with extreme stress (particularly childhood sexual and physical abuse), but this belief has been challenged by the data of multiple research studies. Proponents of

16384-422: Was required. The concept is scientifically controversial and remains disputed. Critics argue dissociative amnesia is merely a rebranding of the discredited repressed memory concept. Dissociative amnesia is a common fictional plot device in many films, books and other media. Examples include William Shakespeare 's King Lear , who experienced amnesia and madness following a betrayal by his daughters; and

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