An erstwhile productive citizen goes on a rampage and kills a minor. When the case comes up in court, the defense presents it as Dissociative Identity Disorder (DID) based on the fact that the heinous act was conducted by an altar. The prosecution refers to the DID defense as a clever ruse and discredits it. Each of the parties produces multiple expert witnesses kindred to the practice of psychology and their evidence completely contradict one another leaving the jury confused. This is the reality of DID. It is one of the most controversial mental health conditions currently and the subject of extreme debate within and without the psychology profession. Indeed, the dispute even includes whether DID as a disease exists as alleged or at all (Huntjens et al, 2016). Further disputes include its causes, diagnosis, symptoms and treatment. It would, therefore, be correct to say that DID is more of a psychological controversy that a mental condition. This research paper, therefore, looks at the psychological controversy that DID has become.
Background
The first point of the DID controversy lies in its definition. It can however generally be defined as a medical condition where a patient has more than one distinct personalities. These personalities may or may not be aware of each other. The definitions, however, range from extremely dissociated personalities where an individual at some point in time acts absolutely differently from the other. Other definitions are mild to the extreme so that even an extreme memory breakdown or even attention breakdown can be considered as an ingredient of DID. A person with DID is said to have different personalities, different personality states, different identities, possessing different ego states or even having an extreme form of amnesia where activities performed at certain moments in time cannot be recalled at all (Huntjens et al, 2016).
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There is, however, a segment of psychology practitioners who believe that DID is not a mental condition, but rather an advanced manifestation of other medical conditions. Such conditions include schizophrenia and borderline personality disorder (BPD). Indeed, a majority of the patients who have been diagnosed with DID also have the right set of signs and symptoms as to be diagnosed with BPD. This has led to the hypothesis that DID is only a manifestation of BPD. Finally and most controversially, DID has been said to the either a product of poor psychological procedures or an inexistent disorder that is merely the figment of the imagination of a section of psychological practitioners. The allegation about causation is premised on the use of hypnosis for the treatment of certain mental disorders. Research has shown that diagnosed DID patients are extremely hypnotizable. This has created the argument that DID could be a side effect of hypnosis and is therefore caused by faulty interventions (Huntjens et al, 2016).
There has not been a substantial study of DID based on a sample that does not have a prior mental health condition hence this contention has not been fully realized. The contention about DID being a figment of the imagination of practitioners is based on the contention that DID may be used as a scapegoat when a mental condition takes a turn that fails known trends (Dorahy et al, 2014). A more extreme allegation is that DID is a false diagnosis geared towards pecuniary gain. On a different perspective, DID has been of major interest in the arena of criminal law and procedure. It has been used several times in the USA as a defense of major crimes, albeit only with rare success (Klaming & Haselager, 2013). However, that it has successfully been used as a defense in a criminal case shows that even individuals outside the practice of psychology are increasingly accepting its existence.
Signs and symptoms
According to the fifth Diagnostic and Statistical Manual of Mental Disorders, for an individual to be considered to be suffering from DID, they need to have at least two distinct personalities. There should also be an inordinate inability to remember personal information. Generally, a person with DID will act as two or more distinct people alternately. In some cases, a patient can have as many as 16 distinct personalities with the distinctions between them varying irregularly (Schlumpf et al, 2014). It is worthy of notice that severity of symptoms in DID is not based on the number of personalities but on the extremity of distinction. For example, a patient may have as many as ten personalities but all of them only display a mild distinction that may not be easy to detect. On the other hand, a patient may have only two personalities but the two are so distinct that one cannot fit into the lifestyle of the other. One personality may be a polite and benign school teacher with the other having such a violent streak as not to be safe anywhere near children (Schlumpf et al, 2014).
Causes
As indicated above, the causes of DID has been a matter of major controversy. Indeed, there is a segment of practitioners who believe that DID is the manifestation of the mishandling of other medical disorders. It is, however, a fact that an overwhelming majority of individuals diagnosed with DID also have another diagnosed mental disorder (Dorahy et al, 2014). Among the disorders that commonly associated with, DID include BPD and schizophrenia. Further, individuals who have had psychological problems such as substance abuse, eating disorders, sleeping disorders, extreme anxiety and stress based complications, posttraumatic stress disorder and personality disorders have a high propensity for developing PTSD. Another common trend among DID patients is a history of horrific trauma, more so at a younger age. This includes sexual assault, serious or repeated physical assault or a serious injury (Dorahy et al, 2014).
This creates a correlation between serious psychological shock and the advent of DID. This trauma based causation of DID is referred to as developmental trauma. The most controversial cause of DID is based on the hypothesis that it is caused by therapists during professional sessions. This hypothesis is enhanced by the fact that almost all patients diagnosed with DID have a history of therapy for other mental problems. Many therapists use different techniques to take patients back to where an incident that has caused trauma or resulted in the disorder took place. The therapists use memory recovery techniques such as hypnosis. When the patient upon whom such techniques are used is extremely suggestible, DID can result as per the instant hypothesis. DID has also been seen to be present in children as early as three years thus adding to the controversy about the causes of DID and even its existence. Most of the diagnosed children, albeit not have had prior therapy have parents who have had an interaction with DID either as patients themselves or through popular culture. The children may, therefore, exhibit signs of DID based on what they have heard about it, an argument that has been used to extend the notion that DID is a fallacy (Dorahy et al, 2014).
Diagnosis
DID is difficult to diagnose because it is not universally recognized by psychologists. There is, therefore, no standard universal diagnostic procedure. The American Psychology Association (APA) has however provided a diagnosis procedure for DID under section 300.14 of the Diagnostic and Statistical Manual of Mental Disorders (DSM-IV-TR) (Dorahy et al, 2014). The diagnosis goes beyond merely having a distinct personality but actually falling under the control of these personalities discretely and recurrently. The discreetness is signified by memory lapses relating to what has been done by different alters. Normal causations of such prerequisites such as alcohol, narcotics, some forms of medication and other medical conditions must be ruled out for DID to be correctly diagnosed.
Treatment
Fortunately, DID cases are few and far between thus even the most experienced practitioner will only have encountered a few cases. For this reason, however, there lacks a systematic, empirically-supported approach to DID treatment (Slack, 2014). Further, there is also major controversy about how DID should be treated more so based on the fact that the treatment given by therapists is blamed for the advent of DID in some quarters increases the controversy on the approach to treatment. Therefore, most treatment regimens are focused on symptoms. This includes psychotherapy, cognitive behavioral therapy (CBT), hypnotherapy, and eye movement desensitization. Medications are also used for symptom relief as well as treatment of comorbid disorders (Slack, 2014).
Conclusion
It is clear from the above that a lot of controversies are currently ongoing about the general subject of DID. Indeed, the fact that some practitioners do not acknowledge its existence mean that they doubt each and everything about DID. However, the disorder has been found important enough to be acknowledged by the APA as a mental disorder complete with a diagnosis. Further and better research about DID has been hampered by the fact that only a few cases have been diagnosed as compared to other medical conditions. Some practitioners believe that DID is a manifestation of other mental disorders such as BPD with others considering it as a side-effect of some therapy-based interventions such as hypnosis. The little that is known about DID, however, relates to the existence of two or more personalities within a singular person. This will cause the person to think and act differently at some moments in time moments in time, and in most cases forget all about the strange behavior. From without the practice of psychology, DID has featured in both popular culture and criminal procedure where it also remains controversial. Therefore, the controversy and research on DID continue .
References
Dorahy, M. J., Brand, B. L., Şar, V., Krüger, C., Stavropoulos, P., Martínez-Taboas, A., ... & Middleton, W. (2014). Dissociative identity disorder: An empirical overview. Australian & New Zealand Journal of Psychiatry , 48 (5), 402-417
Huntjens, R. J., Wessel, I., Ostafin, B. D., Boelen, P. A., Behrens, F., & van Minnen, A. (2016). Trauma-related self-defining memories and future goals in Dissociative Identity Disorder. Behaviour Research and Therapy , 87 , 216-224
Klaming, L., & Haselager, P. (2013). Did my brain implant make me do it? Questions raised by DBS regarding psychological continuity, responsibility for action and mental competence. Neuroethics , 6 (3), 527-539
Schlumpf, Y. R., Reinders, A. A., Nijenhuis, E. R., Luechinger, R., van Osch, M. J., & Jäncke, L. (2014). Dissociative part-dependent resting-state activity in dissociative identity disorder: a controlled FMRI perfusion study. PloS One , 9 (6), e98795
Slack, C. (2014). Dissociative identity disorder: improving treatment outcomes. Counselling & Psychotherapy Journal , 14 (1), 43-45
