Multiple Personalities - Only in America?

[MikeSun5]

I've been reading recently about Dissociative Identity Disorder and how most diagnosed cases come from N. America. Is having multiple personalities an invention of Hollywood, or is it a legitimate disorder? Or is it a legitimate disorder that people think they get because of Hollywood?

I found an earlier thread that brought up the novel/movie Sybil and how the girl's therapist basically created her personality disorder. In reading about DID, I found there was plenty of controversy regarding the legitimacy of its claims.

Some websites say it's a totally valid, diagnosable, and treatable disorder, while other people claim it's bogus.

I know the JREF has posters from all over, so I was wondering if there are cases of multiple personalities, or DID, in places other than N. America. Does this happen all over the place, or it more like entertainment-media-induced American mass hysteria?

 

[Jeff Corey]

This article says it is more prevalent in North America, if so I blame the bogus book and movie "The Three Faces of Eve". http://www.fortea.us/english/psiquiatria/dissociative.htm

 

[Dancing David]

The main problem with the diagnosis is the rule out for substance abuse. Of the very few peopel I worked with who had a diagnosis of DID they had major histories of childhood trauma, head injury and cocurrent substance abuse.

Often it is one of those silly labels that one person gives and the client clings to it. Not as remakable but similar to a client I knew who clung to a boderline label and railed against the label of narccisim.

 

[MikeSun5]

I guess I'm wondering whether or not a person who had no previous knowledge of DID could still "catch" it. Would the symptoms even appear if the patient didn't know about it from TV or whatever? I'm really curious as to how common DID diagnoses are in countries where it's not publicized commercialized.

I found this quote:

Eugene Levitt, a psychologist at the Indiana University School of Medicine, noted in an article published in Insight on the News (1993) that "In 1952 there was no listing for [DID] in the DSM, and there were only a handful of cases in the country. In 1980, the disorder [then known as multiple personality disorder] got its official listing in the DSM, and suddenly thousands of cases are springing up everywhere."

If it weren't for excited therapists and avid readers/moviegoers, would this thing even exist?

I'm almost skeptical about the drug-abuser and trans-gender stories of DID. I wonder if those diagnoses are somewhat pushed on the patient, too? And if this is indeed a fabricated disorder, I wonder what the hell was wrong with the people that were diagnosed...

 

[Roma]

Order this little book for just three bucks and you'll find out:

http://www.amazon.com/Hoax-Reality-Multiple-Personality-Disorder/dp/1568218540

 

[MikeSun5]

Order this little book for just three bucks and you'll find out:

http://www.amazon.com/Hoax-Reality-Multiple-Personality-Disorder/dp/1568218540

Have you read that book? If so, does it answer the questions I brought up? The reviews written for that book basically say that it's still a big controversy. Apparently the author provides evidence for both sides of the argument...
Also that book only seems to deal with the disorder itself, not really addressing it in terms of countries. Unless I'm wrong about that.

I was reading part of a book by Michael Shermer that claims (page 150) that there have been diagnoses of DID in the Netherlands and other European countries, but only recently. He mentions various mental illnesses from other countries he thinks are similar, but none that really match the symptoms of "American" DID.

Even Mr. Shermer - who usually loves things in black and white - uses ambiguous buzz words like "perhaps" and "possibility" when addressing multiple personality disorder.
*sigh* There are accredited sources speaking up for both sides. How frustrating.

 

[Aepervius]

I guess I'm wondering whether or not a person who had no previous knowledge of DID could still "catch" it. Would the symptoms even appear if the patient didn't know about it from TV or whatever? I'm really curious as to how common DID diagnoses are in countries where it's not publicized commercialized.

I found this quote:


If it weren't for excited therapists and avid readers/moviegoers, would this thing even exist?

I'm almost skeptical about the drug-abuser and trans-gender stories of DID. I wonder if those diagnoses are somewhat pushed on the patient, too? And if this is indeed a fabricated disorder, I wonder what the hell was wrong with the people that were diagnosed...

Wiki says that DID diagnosis vary wildly. For example
Country ↓ Prevalence ↓
India 0.015%
Switzerland 0.05-0.1%
China 0.4%
Germany 0.9%
The Netherlands 2%
U.S. 10%
U.S. 6-8%
U.S. 6-10%
Turkey 14%

 

[whatthebutlersaw]

The people treating/questioning Swedish alleged serial killer Thomas Quick suggested that he "done the bad murders" under the influence of a secondary personality called "Ellington".

This was later refuted and it is strongly indicated that Thomas Quick is more of a serial confessor rather than an actual serial killer. He is a very disputed case, mainly because he was basically fed information about the cases he confessed to (much like the recent US case that has been discussed on this board) during his trials, and Swedish (and to some small part Norwegian) officials - instead of questioning the methods for questioning Quick - took the opportunity to close cold cases. There is still a possibility that Quick is a killer, but not a serial killer.

 

[MikeSun5]

Wiki says that DID diagnosis vary wildly. For example
Country ↓ Prevalence ↓
India 0.015%
Switzerland 0.05-0.1%
China 0.4%
Germany 0.9%
The Netherlands 2%
U.S. 10%
U.S. 6-8%
U.S. 6-10%
Turkey 14%

I saw that, but that data assumes the disorder wasn't "pushed" upon the patient. From what I've read, it almost looks like it was...

I looked up that wiki source link for the 14% Turkish stat. This is how they did it. They gave 43 psychiatric patients the Dissociative Experiences Scale test, and 17 people scored over 25 -- which shouldn't really mean much since only 17% of people who score over 30 were shown to have it in a study of over a thousand people (link below). So out of those 17 patients that scored over 25, they determined that every single one of them had a dissociative disorder of some type, and six of them had full blown Multiple Personality Disorder. What are the odds of that in such a tiny test group?

I looked up the Dissociative Experiences Scale test to see what it was about. The questions are really leading. I even found myself trying hard to recall certain instances that might keep me from answering "Never" -- as if I wanted to score well on the test.

My results were disappointing. I'm only one person so far. I do have hope though, as "roughly 15% of clinically diagnosed DID patients score below 20 on the DES."

Also, if it's as easy as scoring above 40% on the DES and really hamming it up for the shrink during the last half of this bad boy, pretending to have multiple personalities should be a breeze. Time to start my life of crime.

 

[Dancing David]

Most clinicians who actually work in mental health think the multiple thing is crud, unfortunately there are those who get charge out of helping people that 'no one else can' and also have no ethics about making money..
I have seen some really stupid stuff in my time, like once a woman was having an obvious panic attack, another clinician said 'oh it is her alter', but I did not have the initials after my name to challenge her. (She was one of three hundred clincians), then there was another person who would talk to these clients (different agency) when they were drunk. I pointed out you can't counsel people who are intoxicated. If they make a threat, call the police and have them hauled to the ED to sober up, and then assess them.

 

[MikeSun5]

Yep... the more I read, the more crap it looks...

 

[Dancing David]

Weell people do get disassociative and it is not uncommon, but there are so many factors. Like someone with a mood disorder can get way whacked as can people who drink a lot, seizures disorders really mess with you too.

And then there is always deliberate human behavior.

 

[jasonpatterson]

Most societies have some disorders that are restricted to that group of people. Hikikomori in Japan, Dhat syndrome in India, Wendingo in native Americans, fibromyalgia in the west, and amok in Malaysia (as in running amok) are only a few, there are hundreds.

This is totally my opinion, but it seems likely that these things are mostly more general disorders (anxiety, depression, schizophrenia, etc) that are seen in all societies but are being expressed differently in ways that are established by the culture in which they occur. It doesn't seem too wild to believe that DID might be something similar.

Here's a fun Cracked list of 5 of these disorders, I like Koro the best...

 

[Maia]

Oh, dear Lord... (so to speak.) Do y'all really want to know the answer to this? Because I have done extensive research in this area, and I've also worked with clients who have both PTSD and dissociative disorders. I don't agree with some clinicians whose ideas were formed in an earlier era and who are not willing to look at all the new research, and who are so convinced that they "don't have any clients who are really dissociative". But I don't generally get into debates in this forum and I don't really like to do it. However, there is no legitimate "controversy" here. The existence and prevalence of the dissociative disorders is accepted by the American Psychiatric Association and the American Medical Association. Take out your copy of the Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition, Text Revision,, and turn to page 519. Read about dissociative amnesia, dissociative fugue, dissociative identity disorder, depersonalization disorder, and dissociative disorder not otherwise specified.

Here's some information about the Dissociative Experiences Scale, which is a self-adminstered screening instrument-- not the same as a "test" for a dissociative disorder. Please understand that the DES is an instrument used to screen clients for two much more detailed clinical assessments, the Dissociative Disorders Interview Scale and the Structured Clinical Interview for DSM-IV Dissociative Disorders.


The Dissociative Experiences Scale is a brief self-assessment instrument which asks questions related to the 5 symptom clusters, assessing experiences of depersonalization, derealization, amnesia, identity confusion, and identity alteration (Gleaves & May, 2001; Simeon, 2006).

Validity of the DES:
Psychometrically sound: mean alpha, or internal reliability, of .93, and convergent validity (between the DES and other measures of dissociation) of .67 (van Ijzendoorn & Schuengle, 1996)
Strong test-retest reliability among dissociative disorder patients, correlations of .93 over 2, 4, and 8 week intervals (Dubester & Braun, 1995; Frischholz et al, 1990).


More DES validity:
By comparison: Structured Clinical Interview for DSM-III-R kappa for 21 separate diagnoses averaged .61 (Williams et al, 1992)
The DES distinguished between dissociative disorder patients and students with 98.9% accuracy and a kappa of .93.
The DES distinguished between dissociative disorder patients and eating-disordered patients with 100% accuracy and a kappa of 1. (Gleaves & May, 2001).

The DES has been shown to have cross-cultural validity in the United States, Canada, Netherlands, Turkey, Puerto Rico, Norway, Sweden, Germany, China, and India; versions currently being developed in Japan and Australia. It has been found reliable among children, adolescents, adults, and older adults. (Gleaves &May, 2001; Kluft, 2007; Nilsson & Svedin, 2006; Xiao et al, 2006. ) It has been found to screen accurately for dissociative disorders in groups of males, females, Caucasians, African-Americans, Asian-Americans, and Hispanics (Foote et al, 2001; Gleaves & May, 2001).

Here's more about the prevalence of the dissociative disorders:
Dissociative disorder diagnoses, if correctly made, would represent up to 10% of all psychiatric populations, but are diagnosed in less than 1% of all clients (Coons,1998).

Most common comorbid diagnosis by far is major depression, around 50% (Coons, 1998; Foote et al,2006; Gleaves & May, 2001).
*
I have some detailed information about the incidence and prevalence of dissociative disorders in patients who have already been admitted to outpatient or inpatient psychiatric settings with a co-occuring psychiatric disorder. This is the context in which the Turkish study was mentioned above, and that is why the incidence was so high.

Dissociative disorders usually remain undiagnosed until an average of seven years into therapeutic treatment, by which time the average client has received six to seven separate psychiatric diagnoses (van der Haart, 2005)


Here's some information about the DDIS, which is used to actually test more reliably for a dissociative disorder, as the DES is not:

Dissociative Disorders Interview Schedule is a 131-item structured interview used to assess diagnoses of somatization disorder, major depression, borderline personality disorder, alcohol and drug abuse, and the five DSM-IV dissociative disorders. It also enquires about a range of other experiences such as trauma history and features associated with dissociative disorders, such Schneiderian symptoms (first-rank symptoms of schizophrenia). It has a kappa of .68 (.78 for DID), with sensitivity(false positives) of less than 1% and specificity (false negatives) of 0%. (Ross et al, 1989).

Here's more about the validity of the Structured Clinical Interview for Dissociative Disorders; the SCI really is the gold standard for diagnosis of all serious mental illnesses and mental disorders:

The SCID-D was developed by Steinberg, Rounsaville, and Cicchetti (1990) to assess the presence and severity of symptoms in the 5 areas. Diagnostic reliability assessed for presence/absence of a dissociative disorder, type of disorder, and severity of specific symptoms, with a kappa of .92. (ibid). Boon and Draijer (1991) found a kappa of .98 on presence/absence of dissociative disorder and 1.0 on diagnosis of dissociative identity disorder. The same reliability and validity figures have been found for the latest revised version, the SCID-D-R (Steinberg, 2000).

References

Adolescent Dissociative Experiences Scale-II (A-DES) (Armstrong,
Carlson, & Putnam, 2003)., Retrieved 4/22/09 from http://www.seinstitute.com/pdf_files/a-des.pdf.
Akyuz, G., Dogan, O., Sar, V., Yargic, L., & Tutkun, H. (1999). Frequency of dissociative identity disorder in the general population in Turkey. Comprehensive Psychiatry, 40(2), 151-159.
American Psychiatric Association. (2000). Diagnostic and statistical manual of mental Disorders (Revised 4th ed.). Washington, DC: Author.
Boon, S., & Draijer, N. (1991). Diagnosing dissociative disorders in the Netherlands: A pilot study with the structured clinical interview for DSM-III-R dissociative disorders. American Journal of Psychiatry, 148, 458-462.
Coons, P. (1998). The dissociative disorders: Rarely considered and underdiagnosed. Psychiatric Clinics of North America. 21(3), 637-648.
Durham, R., Chambers, J., Power, K., Sharp, D., MacDonald, R., Major, K, et al.. (2005) Long-term outcome of cognitive behaviour therapy clinical trials in central Scotland. Health Technology Assessment, 9(42), 1-174.
Foote, B., Smolin, Y., Kaplan, M., Legan, M., & Lipschitz, D. (2006). Prevalence of dissociative disorders in psychiatric outpatients. American Journal of Psychiatry, 163, 623-629.
Friedl, M., & Draijer, N. (2000). Dissociative disorders in Dutch psychiatric inpatients. American Journal of Psychiatry, 157, 1012-1013.
Gleaves, D., & May, M.(2001). An examination of the diagnostic validity of dissociative identity disorder. Clinical Psychology Review, 21(4), 577-608.
Haddock, D.(2001). The dissociative identity disorder sourcebook. McGraw-Hill: New York.
Horen, S., Leichner, P., & Lawson, J.(1995). Prevalence of dissociative symptoms and disorders in an adult psychiatric inpatient population in Canada. Canadian Journal of Psychiatry, 40(4), 185-191.
Kluft, R. (2007). The older female patient with a complex chronic dissociative disorder. Journal of Women and Aging, 19(2), 199-137.
Mulder, R., Beautrais, A., Joyce, P., & Fergusson, D. (1998). Relationship between dissociation, childhood sexual abuse, childhood physical abuse, and mental illness in a general population sample. American Journal of Psychiatry, 155, 806-811.
Nilson, D., & Svedin, C.(2006). Evaluation of the Swedish version of Dissociation Questionnarire (DIS-Q), DIS-Q-Sweden, among adolescents. Journal of Trauma and Dissociation, 7(3), 65-89.
Ross, C. (1991). Epidemiology of multiple personality disorder and dissociation. Psychiatric Clinics of North America, 14, 503-517.
Ross, C. (2007). Borderline personality disorder and dissociation. Journal of Trauma and Dissociation, 8(1), 71-80.
Sar, V., Koyuncu, A., Ozturk, E., Yargic, L., Kundakci, T., Yazici, A., et al. (2007). Dissociative disorders in the psychiatric emergency ward. General Hospital Psychiatry, 29, 45-50.
Sierra, M., & Berrios, G. (1999). The Cambridge Depersonalization Scale: A new instrument for the measurement of depersonalization. Psychiatry Research, 93, 53-64.
Simeon, D., Guralnik, O., Schmediler, J., Sirof, B., & Knutelska, M. (2001). The role of childhood interpersonal trauma in derpersonalization disorder. American Journal of Psychiatry, 158(7), 1027-1033.
Simeon, D., Knutelska, M., Nelson, D., Guralnik O., (2003). Feeling
Unreal: A Depersonalization Disorder Update of 117 Cases., Dept. of Psychiatry: Mount Sinai School of Medicine, New York, NY.
Simeon, D., Kozin, D., Segal, K., Lerch, B., Dujour, R.,& Giesbrecht, T. (2008). De-constructing depersonalization: Further evidence for symptom clusters. Psychiatry Research, 157, 303-306.
Steinberg, M. (2000). Advances in the clinical assessment of dissociation: The SCID-D-R. Bulletin of the Menninger Clinic, 64(2), 146-163.
Tutkun, H., Sar, V., Yargic, L., Ozpulat, T., Yanik, M., & Kiziltan, E. (1998). Frequency of dissociative disorders among psychiatric inpatients in a Turkish university clinic. American Journal of Psychiatry, 155, 800-805.
Van Ijzendoorn, M,m& Schuengel, C. (1996). The measurement of dissociation in normal and clinical populations: Meta-analytic validation of the dissociative experiences scale (DES). Clinical Psychology Review, 16, 365-382.
Xiao, Z.,Yan H., Wang, Z., Zhou, Z., Xu,Y., Chen, J., et al. (2006). Trauma and dissociation in China. American Journal of Psychiatry, 163(8), 1388-1391.


The moral of the story: do NOT trust Wikipedia as your source when it comes to psychiatry, psychology, or psychopharmacology. I don't know about the reliability of any other subjects. Also, anecdotes, friend-of-a-friend stories, and the unfortunate extremely dated prejudices of clinicians who decide they know better than the American Psychiatric Association and the American Medical Association (wow, I wish I were that smart!) are, in my opinion, not really the best sources. I'm sorry, but I really feel strongly about this one.

ETA: Oh yeah, and if anyone actually made it to the bottom of this Insanely Long Post (TM), the thing the layperson isn't likely to know (because there's almost no real public knowledge about the DD's), is that there are actually FIVE dissociative disorders, and DiD is only ONE of them.

 

[MikeSun5]

Thanks for your input, Maia.... that was a damn long post, but I made it!

However, there is no legitimate "controversy" here.

I beg to differ... there are plenty that think DID is bunk. (links in the OP)

Read about dissociative amnesia, dissociative fugue, dissociative identity disorder, depersonalization disorder, and dissociative disorder not otherwise specified.

Duly noted. Are these five disorders interconnected? Does one lead to another or something, or do they all stand alone as specific disorders?

Anywho, dissociation isn't controversial, it's the multiple personalities I'm skeptical of.

Also, anecdotes, friend-of-a-friend stories, and the unfortunate extremely dated prejudices of clinicians who decide they know better than the American Psychiatric Association and the American Medical Association (wow, I wish I were that smart!) are, in my opinion, not really the best sources. I'm sorry, but I really feel strongly about this one.

True... but the fact that all this info is taken from the American Psychiatric Association and the American Medical Association kind of lend some credence to this being a recent North American phenomenon. From what I gathered from your references, the research, screeing tests, and interviews are mostly from the US and Canada. Also, your oldest reference was 1991. DID surfaced promininently in fiction in the 1950s. That's a few centuries for the phenomenon to sink firmly into pop culture before the AMA and APA began to research it.

I wonder how many people diagnosed with DID had never heard of multiple personalities prior to their diagnosis... I wonder how many people read books or watched movies about DID before "coming down" with it... probably not many stats on that.

The moral of the story: do NOT trust Wikipedia as your source when it comes to psychiatry, psychology, or psychopharmacology.

From Carson Daly: "Anyone can edit wikipedia? Wow. It's like an encyclopedia of Mad Libs."

 

[Professor Yaffle]

We briefly looked at this area in my Psychology degree, and the comparisons to the false/recovered memories debate - ie how much is iatrogenically created by overenthusiatic therapists.

 

[calebprime]

...However, there is no legitimate "controversy" here. The existence and prevalence of the dissociative disorders is accepted by the American Psychiatric Association and the American Medical Association. ...
...
Here's more about the prevalence of the dissociative disorders:
Dissociative disorder diagnoses, if correctly made, would represent up to 10% of all psychiatric populations, but are diagnosed in less than 1% of all clients (Coons,1998).

Most common comorbid diagnosis by far is major depression, around 50% (Coons, 1998; Foote et al,2006; Gleaves & May, 2001).
...
Dissociative disorders usually remain undiagnosed until an average of seven years into therapeutic treatment, by which time the average client has received six to seven separate psychiatric diagnoses (van der Haart, 2005)

....

ETA: Oh yeah, and if anyone actually made it to the bottom of this Insanely Long Post (TM), the thing the layperson isn't likely to know (because there's almost no real public knowledge about the DD's), is that there are actually FIVE dissociative disorders, and DiD is only ONE of them.

2 points:

The DSM is controversial. The process by which 'disorders' are added is controversial--some psychiatrists critical of the process say that it's political at best.

The part I bolded--the average time to diagnosis and the number of diagnoses--if not an indication of controversy, exactly, is at least an indication of confusion or difficulty. And a long time for a kind of indoctrination.

 

[Maia]

Now, Mike…

True... but the fact that all this info is taken from the American Psychiatric Association and the American Medical Association kind of lend some credence to this being a recent North American phenomenon. From what I gathered from your references, the research, screeing tests, and interviews are mostly from the US and Canada.

Well, first, of all, there’s this:
The DES has been shown to have cross-cultural validity in the United States, Canada, Netherlands, Turkey, Puerto Rico, Norway, Sweden, Germany, China, and India; versions currently being developed in Japan and Australia. It has been found reliable among children, adolescents, adults, and older adults. (Gleaves &May, 2001; Kluft, 2007; Nilsson & Svedin, 2006; Xiao et al, 2006. ) It has been found to screen accurately for dissociative disorders in groups of males, females, Caucasians, African-Americans, Asian-Americans, and Hispanics (Foote et al, 2001; Gleaves & May, 2001).

Also, there’s been a lot of great research done in Turkey and the Netherlands, and some in China. I definitely agree that there needs to be more work done cross-culturally, too. However, see the notation below for the accepted cross-cultural validity of dissociative disorders.

I wonder how many people diagnosed with DID had never heard of multiple personalities prior to their diagnosis... I wonder how many people read books or watched movies about DID before "coming down" with it... probably not many stats on that.

and

The process by which 'disorders' are added is controversial--some psychiatrists critical of the process say that it's political at best.

Honestly, we can all wonder from here to eternity, and talk about how "some" think this, and "they" think that, and she said, he said, but in my opinion, once a disorder is in the DSM-IV-TR and the ICD-10 (the International Statistical Classification of Diseases and Related Health Problems, 10th Revision, Version for 2007), it's really the end of the ball game. (Actually, the entire searchable ICD-10 is online, right here. F 06.05 to F44.9 This is the internationally, cross-culturally accepted coding of (per Wikipedia-- see, even I think that it does have its moments ) "diseases and signs, symptoms, abnormal findings, complaints, social circumstances and external causes of injury or diseases, as classified by the World Health Organization".

The DSM and the ICD-10, controversial?!? Come on... if we're saying this, then we're saying that "Western medicine" or "allopathic medicine" itself is "controversial". Now, if we're talking about that type of "controversy", it's a whole different subject, but in that case, this is exactly where this argument is going. I think that people don't really mean to be making this argument, but don't necessarily realize it, simply because there is virtually no reliable information whatsoever available about the dissociative disorders. It's hard not to think of stupid movies, dumb, irresponsible news stories, and not-very-informed opinions, because that's really about all there is in the public arena. It's very unfortunate that this is the case.

 

[calebprime]

....

The DSM and the ICD-10, controversial?!? Come on... if we're saying this, then we're saying that "Western medicine" or "allopathic medicine" itself is "controversial".

There are many others on this board more knowledgeable than I am, I'm no expert.

I'm saying yes, the huge expansion of the DSM in recent editions is controversial.

Many of these 'disorders' are not like diabetes--a clear imbalance with a clear solution.

Anyway, I know you don't want to debate, but I would gently urge you to be mildly skeptical about these constructions.

They are on a different ground than disorders with clear causes, like stroke, substance abuse, etc.

Perhaps one of the experts here can speak to the DSM.

 

[calebprime]

Here's a quote from the WHO entry F44 for DD:

http://apps.who.int/classifications/apps/icd/icd10online/

These disorders have previously been classified as various types of "conversion hysteria". They are presumed to be psychogenic in origin, being associated closely in time with traumatic events, insoluble and intolerable problems, or disturbed relationships. The symptoms often represent the patient's concept of how a physical illness would be manifest. Medical examination and investigation do not reveal the presence of any known physical or neurological disorder.


Which speaks to the somewhat mysterious nature of these disorders, at least.