The nature, causes, symptoms and diagnosis of psychological disorder, Dissociative Identity Disorder (DID), are not clear and highly controversial. Two different models namely the Sociocognitive model and the Posttraumatic model are put forward explain psychopathologies, diagnosis, and disease etiology associated with DID. The Sociocognitive model suggests that DID, as a psychological disorder, is a product of social and historical circumstances. In contrast, the Posttraumatic model explains that DID disorder occurs because of severe traumas.
According to Spanos (1994), the number of patients suffering from multiple personality disorder increased rapidly over the past 20 years in North America. This diagnosis offered a path for expressing personal frustrations. It also provided one more tool for manipulation. Spanos (1994) suggests that psychotherapy is partially responsible for the occurrence of this disorder. The goal of psychotherapy is to reveal “hidden” personalities if there is a doubt that the patient is suffering for dissociative identity disorder. Psychotherapy can lead to the inducement of the disease.
Hypnosis is commonly used in dissociative identity disorder patients. It is apparent that some individuals can fake hypnotic response or adjust their responses in order to please and meet the expectations of the investigator. Spanos (1994) emphasizes that there are many ambiguities regarding this disorder. Patients with DID often report that they have no memories about their behavior. The amnesia occurs involuntarily and is very similar to a hypnotic amnesia. However, there is a major difference between DID and hypnotic amnesia. While in hypnosis, amnesia does not occur spontaneously, it occurs only when it is suggested (Spanos, 1994).
Spanos also states that the technique of past-life hypnotic regression causes similar consequences as DID. Most of the researchers consider the experiences brought to consciousness by this technique as false. However, the same occurs in DID. There are also multiple selves and they all have different names and different memories. Spanos suggests that the phenomenon of spirit possession is also similar to DID. The phenomenon of spirit possession is present in different cultures and is characterized by presence of one or multiple selves that possess a person. The prevalence of spirit possession depends on cultural context, social and economic status. There is a peripheral possession that allows a person to alter behaviors and manifest certain behaviors that are not acceptable in the culture. This usually occurs in patriarchal societies due to strong behavioral restrictions. In addition, in Malaysia, individuals who work on repetitive jobs can manifest bizarre behaviors. The belief in both cases is that they are not responsible for their behaviors. The spirit that possesses them is considered responsible entity. This cultural belief provides a safe and legal way to express frustrations.
There are cultural differences in the spirit manifestations, but the mechanism is the same in its ground (histrionic). The possessed individual is seen as a victim and receives attention from others. Secondary benefits vary from one culture to another. According to Spanos, all these manifestation are similar, if not the same, as DID. The fact that these kinds of alterations were rarely documented in Russia, France, Great Britain tells us that DID is a cultural phenomenon. The treatment of the disorder relies on the suggestion of the clients and actually induces appearance of other alters. Patients are encouraged to recognize and demonstrate other alters (Spanos, 1994).
David H. Gleaves (1996) provided support for the posttraumatic model. Posttraumatic model explains that disociative identity disorder is a consequence of severe abuse during the childhood period. It is a posttraumatic debility caused by dissociation in an early childhood. Different personalities in one person are dissociated forms of the entire personality. According to Gleaves, the treatment should be based on reconciliation of different ego states. He criticizes the socio-cultural model provided by Spanos and considers that the Sociocognitive model misrepresents both the therapy and the manifestations of DID. Gleaves argues that multiple identity enactment and DID are not the same syndromes. He claims that dissociative identity disorder is characterized by many symptoms. It includes amnesia, symptoms of depersonalization and derealization, change of identity, and others. According to Diagnostic and Statistical Manual of Mental Disorders, 4th Edition (DSM IV), the diagnosis can be made if two or more personalities are present, and if partial amnesia exists. Another critique is aimed towards benefits of the disorder. Gleaves states that the attention that these patients receive is not always positive. The surroundings stigmatize these individuals and act hostile towards them. The prevalence of the disorder increased due to various factors. One of the factors is increased awareness of child abuse, increase interest in PTSD, especially after the Vietnam War. He agrees with Spanos that hypnosis is often used in working with patients suffering from DID. However, he emphasizes that interviews and life report measures are also very important tools. He does not neglect the influence that the therapist may have on occurrence of alters, however he emphasizes that the evidences regarding this issue are inconsistent. In addition, he claims that the disorder can never be entirely iatrogenic (Gleaves, 1996).
The scientific community is not in agreement with many of Gleaves's arguments and come to the rescue of Spanos. Lilienfeld et al., (1999) suggest that Gleaves’s critique is based on poor understanding of Sociocognitive model. The authors conclude that Gleaves's analysis deemphasizes the cultural manifestations and that the history of DID has several valuable lessons to psychotherapists.
Spanos suggests that there is no place in the diagnostics for this type of disorder because it is the product of therapist-patient interaction in the given social and cognitive context. Dissociative identity disorder was called Multiple personality disorder. From the year 1972 to 1986, there have been 6000 cases of DID (Lilienfeld, Lynn & Lohr, 2003). Prior to that, only 79 cases were documented. This epidemic may be explained by the success of the book and the movie called “Sybil” in 1973. The number of reported cases continued to grow after the appearance of “Sybil” in 1973. Earlier cases had one or two personalities, but later cases reported more than two and as many as a dozen personalities.
According to DSM IV, this disorder is one of the dissociative disorders. The main characteristic is that the person manifests in two or more different personality states. These states are called alters and transferring from one alter to another is called switching. It is important to emphasize that these personalities are completely different from the host’s personality. Some researchers claimed that patients have, so called inner helper, a part of personality that is aware of everything and helps in the process of integration.
According to DSM IV, these patients suffer from amnesia regarding important personal information. Host personality knows nothing about the behavior of other alters. However, other alters are aware of the host’s behavior. It is considered that the prevalence is very small. However, findings are not unambiguous. Certain theorists claim that the prevalence for this disorder is 1-2%. There is a female predominance in the prevalence. Research suggests that females are 3 to 9 times more prone to this disorder than men.
In conclusion, DID is one of the most controversial psychiatric diagnoses. The controversies are primarily due to descriptive psychopathologies, diagnosis disease etiology and treatment. Most scientists, including the author of this report, think that since these personalities coexist in the same person, they must be interdependent. This is why they claim that these are not personalities, but rather fragments of personality. On the other hand, Posttraumatic model is favored by some scientists such as Gleaves, which explains that the disorder occurs as a consequence of severe trauma. This explanation is based on the idea that the individual will experience dissociation in order to defend him/her from intensive trauma. When this occurs, they feel like the trauma is happening to someone else. The debate and discussion on DID is unlikely to subside, given the increasingly acrimonious its nature.
References
Gleaves, D. H. (1996). The sociocognitive model of dissociative identity disorder: a reexamination of the evidence. Psychological bulletin, 120(1), 42.
Lilienfeld, S. O., Kirsch, I., Sarbin, T. R., Lynn, S. J., Chaves, J. F., Ganaway, G. K., & Powell, R. A. (1999). Dissociative identity disorder and the sociocognitive model: recalling the lessons of the past.
Lilienfeld, S. O., Lynn, S. J., & Lohr, J. M. (Eds.). (2003). Science and pseudoscience in clinical psychology. Guilford Press.
Spanos, N. P. (1994). Multiple identity enactments and multiple personality disorder: a sociocognitive perspective. Psychological bulletin, 116(1), 143.
