“a Critical Examination of the Models of Dissociative Identity Disorder: a Synthesis of the Posttraumatic Model and the Sociocognitive Model”

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Introduction

Theories are used to define and explain the world around us. In essence, theories are frameworks for explaining various events or processes. (Baron & Byrne, 2003). Claude Levi Strauss (as cited in Fourie, 2001) maintained that a single logic underlies the structure of all theories. Seemingly contradictions between theories can be reduced to binary oppositions. Theories can thus be reduced to oppositional pairs that produce meaning. Therefore, according to Strauss, society can only understand and give meaning to processes through the contradictionary theories from which they emerge. Fundamentally then, a thesis is always followed by an antithesis, and at best, a synthesis of the thesis and the antithesis would result in the best theory of a phenomenon (Sternberg, 2003). Dissociative identity disorder (DID), formerly known as multiple personality disorder, is a dramatic condition in which two or more relatively independent personalities appear to exist in one person (Sue, Sue & Sue, 2003). Because of the complexity of the disorder, many theories have been developed to offer explanations for the cause of the disorder. As with most explanations for complex phenomena, these theories often clash or offer contrasting rationalizations. Controversy also surrounds the disorder because when the disorder became popularised in the 1970’s, the number of cases of DID rose from less than two hundred cases reported worldwide a year to six thousand cases reported each year (Milstone, 1997; as cited in Sue et al, 2003). Some clinicians believe that DID is relatively common but is underreported because of misdiagnosis, others believe that the prevalence of DID is overestimated because of reliance on questionable self-report measures (Sue et al, 2003). In a survey of psychologists conducted by Cormier and Thelen (1998; as cited by Sue et al, 2003), most psychologists believed DID to be a rare but valid diagnosis. Fifty three percent said they did not think the disorder was due to iatrogenic factors (unintended effects of some action by the therapist), whereas one third believed the condition was produced by the use of a technique such as suggestion or hypnosis. This essay does not aim at arguing whether DID exists or not, but rather, looks at two contrasting models of DID, the posttraumatic and sociocognitive models, and attempts a synthesis of the two to offer a more complex and rounded explanation for the causes of DID. The crucial question is not concerned with the existence of DID, but rather on its origins and maintenance. Is DID best conceptualised as a naturally occurring response to early trauma, or as a socially influenced product that unfolds largely in response to the shaping influences of therapeutic practices, culturally based scripts, and societal expectations?

The Elements of DID

Dissociative disorders involve some sort of dissociation, or separation, of a part of a person’s consciousness, memory, or identity (Sue et al, 2003). DID is a rare, severe dissociative disorder, characterised by the presence of two or more distinct personalities within an individual. Each personality is a complex, integrated being with its own name, memories, behavioural traits, emotional characteristics, social relations, employment histories, mental and physical disorders, and psychological test responses (Maxmen, 1986). Another key diagnostic criterion of DID is amnesia, described in the Diagnostic and Statistical Manual of Mental Disorders, 4th edition (DSM-IV, 1994; as cited in Huntjens, Postma, Peters, Woertman, & Van der Hart, 2003), as “the inability to recall important personal information that is too extensive to be explained by forgetfulness”. Common to most DID patients is the frequent reporting of episodes of interidentity amnesia, in which an identity claims amnesia for events experienced by another identity (Huntjens, Postma, Peters, Woertman, & Van der Hart, 2003). Not all dissociative identities within a patient...
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