http://en.wikipedia.org/wiki/Dissociative_identity_disorder
Multiple personality disorder began to emerge as a separate disorder in the 1970's when an initially small number of clinicians worked to re-established MPD as a legitimate diagnosis.[57] In 1974, the highly influential book Sybil was published and six years later the diagnosis of multiple personality disorder was included in the DSM.(1980) As media coverage spiked, diagnoses climbed. There were 200 reported cases of MPD from 1880 to 1979, and 20,000 from 1980 to 1990 Joan Acocella reports that 40,000 cases were diagnosed from 1985 to 1995.
The majority of diagnoses are made in North America, particularly the United States, and in English-speaking countries more generally with reports recently emerging from other countries (!!!)
The DSM does not provide an estimate, and suggests different explanations for the sharp rise in incidence of DID. Possible reasons suggested for the increase in incidence and prevalence of DID over time [/i]include the condition being misdiagnosed
The causes of dissociative identity disorder have not been identified,
From 1880 to 1979 : 200 reported cases of MPD (2 per year )
From 1980 to 1990 : 20,000 cases (2000 per year)
From1985 to 1995 : 40,000 cases (doubled in 5 years )
Diagnoses reached 50,000 by the 1990s, but the FBI failed to validate allegations made against caregivers. Skepticism increased when MPD patients recovered from the behavior, retracted their false memories, and brought successful lawsuits against therapists.[7] A sharp decline in cases followed, and the disorder was reclassified as "dissociative identity disorder" (DID) in DSM-IV.[7] In the 2020s, an uptick in DID cases followed the spread of viral videos about the disorder on TikTok and YouTube.[8]
The number of recorded cases increased significantly in the latter half of the 20th century, along with the number of identities reported by those affected, but it is unclear whether increased rates of diagnosis are due to better recognition or to sociocultural factors such as mass media portrayals.[20] 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.[1][12](p335)
http://environment.newscientist.com/article/mg15120384.800-review--the-splintered-self.html
Strictly speaking, recovered memory and multiple personality disorder (MPD) are independent issues, as Schacter makes clear, but they have been entwined for three reasons. The first is that, according to some data, MPD is frequently caused by severe sexual abuse before the age of five. The second reason has to do with the actions of therapists, who are accused of creating both false memories of sexual abuse and MPD.The third reason is a little more complicated, as both involve loss of memory. People who wish to claim in a court that all recovered memories are false would have a strong and universal defence if they could say there were no mechanisms of memory available that could account for the phenomenon of amnesia that lifts after a twenty-year gap. If this amnesia is genuine, then there has to be a mechanism to explain it, which would account for the amnesia in recovered memory. Members of the British False Memories Society are disbelievers in recovered memory, for example, and they are mostly disbelievers in multiple personalities.
One interesting remark on hearing voices or telepatical messages: it is associated in the first place with DID another pretty new with a sudden and big increaese in numbers in the 80ties that overlaps a lot with all kind of recovered memories experience and is typical for remotely targeted individuals but also for the alien anductees who very often discribe telepatically to communicate with the aliens who abducted them There is also worldwide mayny groups of voichearers comming up and that phenomenon is also pretty recent)
psychiatric categories of patients that hear voices; schizophrenia > (around 50 percent); affective psychosis (around 25 percent) and > dissociative disorders (AROUND 80 PROCENT ) (Honig et al., 1998).
General
The fifth, revised edition of 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.[16](p 118) This contributes to difficulties diagnosing the disorder, and to clinician bias.[16]
DID is rarely diagnosed in children.[6] 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.[1] In children, the symptoms must not be better explained by "imaginary playmates or other fantasy play".[1] 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 the evaluation as well.[32] 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.[24] 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".[17][59]
The diagnosis has been criticized by supporters of therapy as a cause or the sociocognitive hypothesis as they believe it is a culture-bound and often health care-induced condition.[22][6][5] 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.[46] Other researchers disagree and argue that 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).[28] 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 a small number of clinicians who specialize in DID are responsible for the creation of alters through therapy.[22]
The DSM-5 elaborates on cultural background as an influence for some presentations of DID.[1](p 295)
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 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 the former is involuntary, distressing, uncontrollable, and often recurrent or persistent; involves conflict between the individual and their surrounding family, social, or work milieu; and is manifested at times and in places that violate the norms of the culture or religion.
Validity disputed
DID is among the most controversial of the dissociative disorders and among the most controversial disorders found in the DSM-5-TR.[63][22][37] The primary dispute is between those who believe DID is caused by traumatic stresses that split the mind into multiple identities, each with a separate set of memories,[64][24] and those who believe that the symptoms of DID are produced artificially by certain psychotherapeutic practices or by patients playing a role they believe appropriate for a person with DID.[48][5][17][65][61] The debate between the two positions is characterized by intense disagreement.[53][48][6][5][65][61] Research has been characterized by poor methodology.[64] Psychiatrist Joel Paris asserts that the idea that a personality is capable of splitting into independent alters is an unproven assertion at odds with research in cognitive psychology,[46] while David Gleaves argues that recognition of DID was in fact prompted by developments in that field, including theories of parallel-distributed processing.[66]
According to proponents of the trauma model, the ordinary "host" personality experiences memory gaps for their alter personalities. Research has challenged this idea: Richard McNally (2012)[9] found that although patients reported amnesia between alters, objective tests found their memory function was intact.[9]
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 implies that those with DID are especially susceptible to manipulation by hypnosis and suggestion.[67] The iatrogenic model also sometimes states that treatment for DID is harmful. According to Brand, Loewenstein, and Spiegel, "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.[68]
Psychiatrists August Piper and Harold Merskey have challenged 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 rarity 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 the DSM and undefined concepts such as "personality state" and "identities", and question the lack of evidence of childhood abuse (beyond self-reports) in some people with DID, the lack of a defined threshold of abuse sufficient to induce DID, and the extremely small number of cases of children diagnosed with DID despite an average age of three years at the appearance of the first alter.[6] 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 the Dissociative Experiences Scale, Dissociative Disorders Interview Schedule, and Structured Clinical Interview for Dissociative Disorders)[24] in the internal validity range of widely accepted mental illnesses such as schizophrenia and major depressive disorder. In his opinion, Piper and Merskey set their standard of proof higher than it is for other diagnoses. He also asserts that Piper and Merskey have cherry-picked data and not incorporated all relevant scientific literature, such as independent corroborating evidence of trauma.[69]
Treatment
Treatment under the sociogenic model
Proponents of the sociogenic model dispute that dissociative identity disorder is an organic response to trauma, but believe it is a socially constructed behavior and psychic contagion. Paul R. 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". McHugh believed that proponents of dissociative identity disorder inadvertently worsen the patient's condition by validating the behavior and providing attention.[70]
According to McHugh, at Johns Hopkins Hospital doctors should ignore the displays from "alters", and instead focus on treatment for other psychiatric problems patients present with. This method of treatment is reportedly successful:[71]
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 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.
According to a 2014 review, such views are based on anecdotal or non-peer-reviewed findings. In controlled studies, non-specialised treatment that did not address dissociative self-states did not substantially improve DID symptoms, though there may be improvement in patients' other conditions.[68]