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Dissociative Identity Disorder

The disorder previously known as Multiple Personality Disorder is now officially labeled Dissociative Identity Disorder . Cases of Dissociative Identity Disorder show us how the executive part of personality can change within a single person and what the consequences of that change can be for a person's behavior.

How is multiple personality disorder officially labeled now?
How could therapists "make it occur"?

What is the sociocognitive theory of multiple personality from Spanos?

Cases of multiple personality have been known and documented for over 150 years. The syndrome was brought to public attention by several best-selling books that became hit movies: The Three Faces of Eve and Sybil Starting in the 1980s, cases of multiple personality were diagnosed with increasing frequency, perhaps due to widespread knowledge of the condition.

Some psychologists and psychiatrists began to suspect that dissociative identity disorder (DID) was being diagnosed too often. Perhaps therapists and clients were looking for it, making it happen through expectation and suggestion. Another complication occurred when hypnosis was used with such patients (about a quarter of the time, according to Ross, Norton, and Wozney, 1989). People readily make things up during hypnosis, and later they have a hard time distinguishing between hypnotic confabulations and real memories.

Nicholas P. Spanos (1994) asserted that multiple personality is a "social construction" serving the needs of the patient and sometimes the therapist. He pointed out that the syndrome had apparently changed its nature since becoming popular in the 1980s. Older cases seldom involved more than two or three personalities, now it was common for people to claim dozens of "alters." Spanos also pointed out that many psychiatrists had gone 40 or 50 years without ever seeing a case of multiple personality, yet others seemed to discover it in dozens of patients. Spanos argued that DID was a form of role-playing between patients, who may seek the attention or fascination of a therapist, and therapists who are eager to discover the syndrome. He called his theory a sociocognitive explanation of multiple personality.

The Spanos thesis sparked a sharp reaction from many critics (e.g. Gleaves, 1996). However, Spanos was not alone in his skepticism. Psychiatrists Thigpen and Cleckley, authors of The Three Faces of Eve, also believed the multiple personality syndrome was being diagnosed far too often. They wrote:

What did Thigpen and Cleckley think about the incidence of multiple personality?

Over the past 3 decades we have together seen tens of thousands of psychiatric patients. Other than Eve, we have seen only 1 case (presented by a psychiatrist in Georgia) that appeared to be undeniably a genuine multiple personality. (Thigpen & Cleckley, 1984)

Thigpen and Cleckley went on to say that they had seen hundreds of cases referred to them by other therapists as multiple personality patients. Most turned out to be people seeking attention, trying to evade responsibility for crimes, or looking for a dramatic change in an unsatisfactory life, but not authentic cases of multiple personality.

What suspicions have been cast on the classic case of Sybil? What does "iatrogenic" mean?

Even the classic case of Sybil may have been caused by the therapist's leading questions while the client was under hypnosis. The made-for-TV movie version of Sybil includes a scene where physical evidence proves her childhood memories are authentic, but the book has no such scene. In 1998, shortly after the real-life individual that Sybil was based upon died, a psychologist who inherited papers from the principle psychiatrist involved (Dr. Wilber) says they show Sybil's multiple personality was iatrogenic (caused by the doctor) rather than occurring spontaneously.

Skepticism is warranted whenever a psychological disorder becomes too popular or profitable, and dissociative identity disorder has been both: it caught the public's attention in the second half of the 20th Century, and there were moneymaking books and movies about it. However, evidence indicates that multiple personality is neither a fraud nor a modern invention. In a 1944 review, Taylor and Martin (1944) reported 76 cases in the English language literature. The earliest report they found was written by a Dr. Mitchill in 1817. The paper was titled, "A Double Consciousness, or a Duality of Person in the Same Individual."

How was Mary Reynolds typical of DID patients?

That case involved a young woman named Mary Reynolds whose family came to Pennsylvania from England in 1797 when Mary was four. The original personality was melancholy and shy. The second personality (which emerged when she was 19) was "witty" and "fond of company." After a period of alterations, the second personality became dominant. When Mary was 36 only the second personality remained, and it continued to be the only one until her death at 61.

Why are there no cases of DID reported from before 1800?

Mary Reynolds was typical of multiple personality patients. She had a strict upbringing. Her original personality was shy and sad, but her second personality was uninhibited and fun loving. (The same basic pattern was found in the famous case of Eve, which also seems to be authentic, because an alternate personality wrote a letter to the therapist before there was any hypnosis.) No doubt there were cases of multiple personality before 1817; but they were probably categorized as cases of demonic possession (Hilgard, 1986).

What are the common elements in case histories of DID?

The common element in nearly every authentic case of multiple personality is severe trauma in childhood. Dissociative Identity Disorder (DID) has been called a "post-traumatic stress syndrome of childhood origin" (Chance, 1986). Apparently, under the stress of severe discipline, sexual abuse, or traumatic confrontations with death, certain children allow their normal "self" to take retreat into unconsciousness while another part emerges to absorb the punishment or deal with the trauma. As Ross (1989) put it, "What is MPD? MPD is a little girl imagining that the abuse is happening to someone else" (p.72).

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