Most people with
DID see several therapists and have an average of seven diagnoses before
finally finding someone who understands the dissociative aspect of their
behaviour.
Part of the reason
for this problem is that too few therapists are trained in the diagnosis and
treatment of DID. Furthermore, many therapists do not believe in the existence
of the disorder despite its inclusion in the Diagnostic and Statistical Manual
of Mental Disorders (DSM) (The
Dissociative Identity Sourcebook see BOOKS, ARTICLES)
THE DSM (Diagnostic & Statistical Manual of Mental Disorders)
is published by the
American Psychiatric Association. It is used in Canada and the U.S., as well as
other parts of the world, to diagnose mental illnesses.
The International Statistical Classification of Diseases and Related Health
Problems (ICD), produced by the World Health Organization (WHO), is another
commonly used manual which includes criteria for mental disorders. This is in
fact the official diagnostic system for mental disorders in the U.S., but is
used more widely in Europe and other parts of the world. The coding system used
in the DSM is designed to correspond with the codes used in the ICD, although
not all codes may match at all times because the two publications are not
revised synchronously.
The condition of multiple personality was first obviously called Multiple
Personality Disorder or MPD.
DSM-IV renamed it
Dissociative Identity Disorder (DID) for two reasons.
- First, to emphasize that there is the absence of a single unified identity rather than the presence of personalities
-
Second, while “personality” usually refers
to a characteristic pattern of thoughts, feelings, moods and behaviour of the
whole person, the switches between identities and behaviour patterns is the true
“personality” of someone with DID meaning an identity that is characterized by
dissociation.
The ICD, however, continues to call it MPD.
The latest version of the DSM is DSM-V. Its criteria states that multiple
personality is characterized by
- a disruption of identity characterized by
two or more distinct personality states;
- or an experience of possession (to include other cultures);
- the sense of identity, behaviour, mood, perceptions and/or memory are not continuous;
-
the fact that it can be seen by others or
reported by the person themselves;
-
amnesia - may be unable to recall important
personal information for everyday or traumatic events that is not normal or
ordinary.
FITTING THE DSM
CRITERIA
There may be only 1 in 1000, or fewer, persons who fit the criteria exactly
for multiple personality in the DSM.
HOWEVER …
It may be more like 1 in 100 who fit some kind of definition of multiple
personality. Reasons for this?
- The difference between personalities may not be so distinct - "the personalities [created] need only be as distinct, public and elaborate as becomes necessary in the handling of stressful situations" (Clinical Presentations of Multiple Personality Disorder);
- the condition may be well hidden for several reasons so it’s not as easy to diagnose;
- communication between the personalities may be good enough that the person appears to have continuous identity, behaviour, memory, etc.;
- only one personality may be out for a long period of time so it appears to be only one person to an observer, even to a clinician who is very knowledgeable about MPD/DID;
-
the
personality who is out does not know about the other personalities or if she
does know she won’t tell because she is afraid she will be labelled crazy.
.. if a clinician
is expecting the classic presentation of MPD, like that of Sybil .. or Eve ..,
he or she will most likely miss its presentation altogether the majority of the
time. Contrary to popular belief, people with MPD do not always have clear-cut,
dramatic, overtly expressed separate identities. Often their symptoms are more
mild or subtle than is typically believed. Further, their symptoms may be
inconsistent, sometimes varying from day to day, or may be suppressed or
hidden. In contrast to what the public observes on talk shows, it is more
common to encounter a patient who conceals his or her condition than one who
openly expresses it. .. There is also the possibility that only the main or
host personality, who often has no knowledge of the other personalities, will
ever be assessed. (The Diagnosis of
Multiple Personality Disorder: The Debate Among Professionals see BOOKS, ARTICLES)
