Some claim that treatment for dissociative identity disorder (DID) is harmful. Others maintain that the available data support the view that psychotherapy is helpful.
We review the empirical support for both arguments.
Current evidence supports the conclusion that phasic treatment consistent with expert consensus guidelines is associated with improvements in a wide range of DID patients' symptoms and functioning, decreased rates of hospitalization, and reduced costs of treatment. Research indicates that poor outcome is associated with treatment that does not specifically involve direct engagement with DID self-states to repair identity fragmentation and to decrease dissociative amnesia.
The evidence demonstrates that carefully staged trauma-focused psychotherapy for DID results in improvement, whereas dissociative symptoms persist when not specifically targeted in treatment. The 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. Given the severe symptomatology and disability associated with DID, iatrogenic harm is far more likely to come from depriving DID patients of treatment that is consistent with expert consensus, treatment guidelines, and current research.
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... As with previous empirical investigations [17,48], the results from the current study do not support the hypothesis that treatment of CDD is associated with iatrogenic harm. According to some scholars , interventions focused on dissociative parts will reinforce the patient's incorrect beliefs about having multiple identities, thereby worsening symptoms and functioning and causing harm to patients. ...
Patients with complex dissociative disorders (CDD) report high levels of childhood- abuse experiences, clinical comorbidity, functional impairment, and treatment utilization. Although a few naturalistic studies indicate that these patients can benefit from psychotherapy, no randomized controlled trials have been reported with this patient-group. The current study evaluates a structured protocolled group treatment delivered in a naturalistic clinical setting to patients with CDD, as an add-on to individual treatment.
Fifty nine patients with CDD were randomized to 20 sessions of stabilizing group–treatment, conjoint with individual therapy, or individual therapy alone, in a delayed-treatment design. The treatment was based on the manual Coping with Trauma-Related Dissociation . The primary outcome was Global Assessment of Functioning (GAF), while secondary outcomes were PTSD and dissociative symptoms, general psychopathology, and interpersonal difficulties.
Mixed effect models showed no condition x time interaction during the delayed treatment period, indicating no immediate differences between conditions in the primary outcome. Similar results were observed for secondary outcomes. Within-group effects were non-significant in both conditions from baseline to end of treatment, but significant improvements in psychosocial function, PTSD symptoms, and general psychopathology were observed over a 6-months follow-up period.
In the first randomized controlled trial for the treatment of complex dissociative disorders, stabilizing group treatment did not produce immediate superior outcomes. Treatment was shown to be associated with improvements in psychological functioning.
Clinical Trials ( NCT02450617 ).
... Mental health professional training should focus more on the psychopathology of DDs and highlight current evidence about the understanding, assessment, and treatment of the disorders, and dispel their common myths. 12 In addition, although assessment and diagnosis of DDs are challenging, standardized assessment tools can be used for screening DDs and facilitating differential diagnosis. Therefore, general mental health assessment should include valid dissociation measures to avoid overlooking DDs. ...
In this editorial paper, we highlight 5 major challenges in the
diagnosis and the treatment of DDs and provide suggestions to address these impediments.
... In this etiological scenario, the complex polysymptomatic profile does not "become" DID until iatrogenic and sociocultural influences shape its expression into the features of the disorder. Lynn et al. (2019b) summarized critiques of the SCM and defenses of the PTM, including contentions that (a) sociocognitive influences neither are particularly impressive nor preclude a role for trauma in dissociation; (b) weak correlations between dissociation and trauma may be explained by low levels of clinical trauma and/or dissociation in nonclinical samples; (c) evidence for the correlation between suggestibility/false memory and dissociation is often weak or modest in size; (d) via a common link through trauma history, the association of dissociation and fantasy proneness may be spurious; (e) even in cultures with minimum exposure to dissociation in popular media, dissociative disorders can still be diagnosed (e.g., Turkey, China, Taiwan) (Chiu et al. 2017a,b); ( f ) the idea that DID is induced by iatrogenic influences in psychotherapy has been subject to criticism (see Brand et al. 2014, Elzinga et al. 1998; and, we would add, (g) the SCM is a broad perspective rather than an articulated theory, and so it lacks limits and is difficult to falsify. ...
For more than 30 years, the posttraumatic model (PTM) and the sociocognitive model (SCM) of dissociation have vied for attention and empirical support. We contend that neither perspective provides a satisfactory account and that dissociation and dissociative disorders (e.g., depersonalization/ derealization disorder, dissociative identity disorder) can be understood as failures of normally adaptive systems and functions. We argue for a more encompassing transdiagnostic and transtheoretical perspective that considers potentially interactive variables including sleep disturbances; impaired self-regulation and inhibition of negative cognitions and affects; hyperassociation and set shifts; and deficits in reality testing, source attributions, and metacognition. We present an overview of the field of dissociation, delineate uncontested and converging claims across perspectives, summarize key multivariable studies in support of our framework, and identify empirical pathways for future research to advance our understanding of dissociation, including studies of highly adverse events and dissociation.
... There has been increased awareness that psychotherapy can cause harm. This conception is related to opinion pieces, anecdotal cases, unpublished reports of damage and its substantiation, misunderstandings about DID treatment, misrepresentations of data, and DID phenomenology [45,46]. A medical professional can conduct the appropriate type of treatment for mental health disorders with special training in this field. ...
Dissociative identity disorder (DID), previously referred to as multiple personality disorder (MPD), is often discounted, neglected, and misunderstood by the health care system and society. Although the developing world tends to view the condition as a spiritual phenomenon, the scientific community considers it to be a pathopsychophysiological disorder. DID-afflicted individuals typically have impaired integration of consciousness, identity, memory, feelings, thought processes, and perceptions of their environment. DID may also present other serious morbidities, such as depression, insomnia, and substance abuse. A well-known cause of DID is severe early childhood trauma, including extreme neglect by parents or siblings and repetitive physical, emotional, or sexual abuse. This condition can be exacerbated by environmental conditions and biological vulnerability to stress and stressors. DID is diagnosed by physical examination, psychiatric assessment, and sometimes brain imaging, or electroencephalogram. Although unclear, several changes are reported in a DID-patient's brain. Currently, no specific therapy is available as DID treatment. Nevertheless, DID is typically managed with a symptomatic approach and psychotherapy. The phase-based approach and schema therapy-proposed by practice-based clinical guidelines and evidence-based research-are now available for the treatment of DID patients. Further research is warranted to evaluate DID's pathophysiology and treatment options, considering its adverse impact on society and co-morbidities.
... Opposing this "fantasy model" of dissociative identity phenomena, the more current "trauma model" highlights dissociation as a reaction to extreme threat rather than an inherent pathology of personality (Floris & McPherson, 2015). Identity dissociation represents an adaptive reaction to an inescapable threat or danger in which flight or fight is impossible (Brand, Loewenstein, & Spiegel, 2014), establishing an intrapsychic resolution to extreme ambivalence (Maiese, 2016) and allowing the preservation of multiple self-states that exist naturally in children, but which tend to be less obvious or present in adults (Itzkowitz, Chefetz, Hainer, Hopenwasser, & Howell, 2015). Where an event is overwhelming, and feelings about the event are inadmissible to the self or impossible to resolve (perhaps incorporating deep confusion about whether to live or die), other identities can form, electing to bear the experience and carry some of the ambivalent feelings, leaving the other parts of self able to survive and even thrive. ...
In this reflexive case‐study, “Billie”, an integrative psychotherapist, and her therapist, Nicola, offer a coproduced account of Billie's lived experience of dissociative identity. Challenging the medicalised “fragmentation towards integration” discourse, Billie, her parts, and Nicola coproduce a person‐centred “exclusion towards inclusion” approach. The authors propose the term “plural identity”, situating the experience less as a disorder, and more as a way of being human. They present verbatim extracts of their therapeutic work, with parallel commentary and postsession discussion, to illustrate their developing, person‐centred and coproduced approach towards intrapsychic inclusion. They conclude that inclusion consists in unconditionally valuing three prevailing constituents in plural identity: the individual parts of self; the ecological system; and the differentiation between parts. This can result in growth for all parts, including parts that initially appear counter to growth, and allows the lived experience of the client to be honoured, not pathologised.
... https://jrtdd.com -many with Borderline Personality Disorder -by clinicians who believe in "repressed memories" and "multiple personalities" using "risky" treatments like hypnosis for "recovered memory therapy" to exhume forgotten traumas as the primary treatment goal, but instead "implant" false memories (Loewenstein, et al., 2017;Paris, 2012;Brand, Loewenstein & Spiegel, 2014). "Fantasy-prone" is a specific construct from hypnosis and cognitive research, which is described from healthy samples whose were highly hypnotisable with ability to generate an extraordinarily vivid, compelling fantasy life with cognitive slippage and difficulty in made difference between internal and external experience (Brand, Loewenstein & Lanius, 2014). ...
Background: Dissociative symptoms are most commonly found in females and adolescents, and when discussing their background, they can be from lower socio-economic backgrounds and rural areas. They are always preceded by psychosocial stressors. Dissociative disorders previously known as “hysteria” have been described since antiquity and Hippocrates even hypothesised “wandering uterus” to be the cause for dissociation in females. With the advances in science, there has been shift from these religious and spiritual concepts to a scientific basis for dissociation.
Aim: To assess the dissociative phenomenology in normal population and to assess the subjective health in normal population.
Methods: A group of 100 (50 females & 50 males) were selected from the community using a snowball sampling technique.
Tools: Socio-demographic data sheet, General Health Questionnaire-12 and Dissociative Experience Scale-II were used.
Results: The study found that females differ from males in the reporting of subjective health rating (X2=5.76, p=0.01) and similar results shown in terms of dissociative phenomenology (X2=67.76, p=0.001).
Discussion: It has been found that only 4% from the female group and 2% from the male group rated their health under the “normal” category. 52% of females and 64% of males were categorised under “mild ill health” and 24% to 26% were in “moderate ill health”, whereas 20% of female participants and 8% of male participants rated their health as “severely ill”. In another domain of the study, dissociative phenomenology, 32% of female participants reported severe dissociative symptoms and 38% of male participants also showed similar results.
Conclusion: Dissociative disorder significantly affects the population but it is hard to diagnose due to factors such as; cultural factors, socio-economic factors etc. The study shows clearly that dissociative symptoms are found in the general population also.
... A common, erroneous idea is that hypnosis is used primarily for "memory recovery" in DID therapy (American Society of Clinical Hypnosis Committee on Hypnosis and Memory, 1994;Brown, Scheflin, & Whitfield, 1999;Kluft, 2012). In the vast preponderance of situations, hypnosis in DID is used for symptom management, containment, grounding, etc. Far from using hypnosis for unearthing "repressed memories," in work on traumatic memories in DID, hypnotic techniques are used to moderate the impact of overwhelming PTSD flashbacks: disorganizing, disorienting, posttraumatic auditory, visual, tactile, olfactory, gustatory, somatic, and/or somatosensory intrusions (Brand, Loewenstein, & Spiegel, 2014; International Society for the Study of Dissociation et al., 2011). Experts point out that, due to the naturalistic occurrence of spontaneous auto-hypnotic phenomena in DID, no treatment of DID occurs without "hypnosis" (International Society for the Study of Dissociation et al., 2011;Kluft, 2012). ...
Courts struggle with questions of how to assess competency to stand trial (CTS) and not guilty by reason of insanity (NGRI) in dissociative identity disorder (DID). Concerns about CTS include dissociative amnesia and unpredictable switching behaviors that could cause inconsistent information transfer across self states, with the defendant unable to access important legal information about his/her defense and to collaborate with his/her attorney; DID defendants could not conform their conduct to the law or know right from wrong due to dissociative amnesia, the seemingly independent actions of self states, and the disruption of reality testing by switching. The author presents the case of a woman charged with both a witnessed and an unwitnessed burglary and arson, the latter at the home of her former therapist. The author was the fourth forensic evaluator in the case. Disagreements included whether the defendant met diagnostic criteria for DID or was malingering, and whether she was CTS and/or NGRI. In clinical work with DID, “the whole human being” is held responsible for all behavior, despite reported amnesia or lack of subjective agency. The Discrete Behavioral States (DBS) model of DID avoids reification of the DID self states and their conflation as separate “people.” This model supports evaluating the defendant at the level of specific self states, the self-state system, and that of the whole human being. The author concluded that the defendant met diagnostic criteria for DID and also was malingering its severity. She was competent to stand trial and legally sane.
Ideas about dissociation—the causes, including its role as sequelae of trauma—are viewed very differently by some clinicians and researchers. Yet, dissociation is a common symptom among trauma survivors. Like the theoretical camps in psychotherapy approaches, there are strong views on why some people develop problematic dissociation. I will discuss some of these controversies and will speak to research which suggests that dissociation can occur on a continuum of normal to excessive. I’ll provide some context for theoretical disagreements, which may stem from cultural and some mental health clinician’s and researcher’s historical tendency to disavow aspects of trauma, particularly childhood trauma. Finally, I will discuss treatment approaches for people with excessive dissociation.
In the Netherlands, the diagnosis of dissociative identity disorder (DID) is widely accepted, although skeptics also have made their opinions known. Dutch clinicians treating DID patients generally follow the common three phase model for treatment of post-traumatic stress. Given the fact that they usually deal with complicated cases and enmeshed patients (cf. Horevitz & Loewenstein, 1994), most often treatment is restricted to Phase 1: stabilization and symptom reduction. Treatment of higher functioning patients, on the other hand, usually aims at processing of traumatic memories and complete personality integration as well. In this article, two Dutch cases are described in detail, with a special emphasis on the clinical deliberations which, in the first case, led to the decision to proceed to trauma treatment, and which led in the second case to the decision to refrain from it. The current standard of care with regard to the treatment of trauma-induced disorders, including post-traumatic stress disorder and many dissociative disorders, entails, among other things, the application of a phase-oriented treatment model (. Phase-oriented trauma treatment has its origins in the pioneering work of Pierre Janet (1898, 1919/25), who described three phases in the overall treatment: 1) stabilization and symptom reduction; 2) treatment of traumatic memories; and 3) personality reintegration and rehabilitation (van der Hart, Brown, & van der Kolk, 1989). In the Netherlands, clinicians usually follow Janet's terminology, while mentioning the following treatment goals for each separate phase: 1) overcoming the phobia of dissociative identities; 2) overcoming the phobia of traumatic memories; and 3) overcoming the phobia of normal life and attachment (Nijenhuis, 1994; Nijenhuis & van der Hart, in press; van der Hart & Boon, 1998). In actual clinical practice the model is not applied in a strict linear model, but rather takes the
The article gives a short review of how knowledge and competence on dissociative disorders have developed in Stavanger, Norway. The main part of the article describes two patients with dissociative disorders. The first of these cases describes a middle-aged female patient with a long psychiatric history with different psychiatric diagnoses. She was the first among our patients to get the MPD diagnosis in 1992. The other case presents a young man diagnosed with DDNOS during his first stay in the psychiatric department in 1993. The diagnosis later on was changed to MPD. Their treatments within the Norwegian mental health system are illustrated.