Questionable Aspects of the Diagnosis and Treatment of Dissociative Identity Disorder

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Questionable Aspects of the Diagnosis and Treatment of Dissociative Identity Disorder

Few psychiatric diagnoses have garnered as much controversy as that of Dissociative Identity Disorder, or DID. The fourth edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-IV) defines the disorder, formerly called Multiple Personality Disorder, as the existence of “two or more distinct identities within the individual” (as cited by Elzinga, van Dyck, & Spinhoven, 1998). Elzinga et al. (1998) identify three major controversies surrounding DID: whether the disorder is caused inadvertently through therapy (an effect called iatrogenesis), whether memories of sexual abuse often associated with DID are also the result of suggestion during therapy, and whether there has been an overdiagnosis of DID in recent decades. Lilienfeld, Lynn, and Lohr (2003) point out that many surveyed clinicians find the diagnosis itself to be questionable. A 1999 survey of American psychiatrists found that only 25% believe there is evidence to support DID as its own diagnostic category. Despite this controversy, the diagnosis and its criteria remained in the 2000 revision of the DSM-IV (Lilienfeld et al., 2003).

Our current description of the disorder can be traced back to the work of the French neurologist Pierre Janet, who first conceptualized dissociation, or a mental process causing the separation of certain thoughts and emotions from an individual’s identity (Lilienfeld et al., 2003). The presence of two distinct “identities” was reported in the case of the first psychoanalysis patient, Bertha Pappenheim (alias Anna O.), an Austrian woman treated by Freud’s mentor, Josef Breuer (Weissberg 1993). Weissberg suggests that this may be the first case of therapy-induced DID; Pappenheim’s dissociative symptoms appeared only during the course of treatment by Breuer, and it is possible that Breuer unintentionally implanted false memories while she was under hypnosis. Although...
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