Definitions[ edit ] Dissociationthe term that underlies the dissociative disorders including DID, lacks a precise, empirical, and generally agreed upon definition. Thus it is unknown if there is a common root underlying all dissociative experiences, or if the range of mild to severe symptoms is a result of different etiologies and biological structures. Psychiatrist Paulette Gillig draws a distinction between an "ego state" behaviors and experiences possessing permeable boundaries with other such states but united by a common sense of self and the term "alters" each of which may have a separate autobiographical memoryindependent initiative and a sense of ownership over individual behavior commonly used in discussions of DID. Efforts to psychometrically distinguish between normal and pathological dissociation have been made, but they have not been universally accepted.
Definitions[ edit ] Dissociationthe term that underlies the dissociative disorders including DID, lacks a precise, empirical, and generally agreed upon definition. Thus it is unknown if there is a common root underlying all dissociative experiences, or if the range of mild to severe symptoms is a result of different etiologies and biological structures.
Psychiatrist Paulette Gillig draws a distinction between an "ego state" behaviors and experiences possessing permeable boundaries with other such states but united by a common sense of self and the term "alters" each of which may have a separate autobiographical memoryindependent initiative and a sense of ownership over individual behavior commonly used in discussions of DID.
Efforts to psychometrically distinguish between normal and pathological dissociation have been made, but they have not been universally accepted. Other DSM-5 symptoms include a loss of identity as related to individual distinct personality states, and loss referring to time, sense of self and consciousness.
Individuals with DID may experience distress from both the symptoms of DID intrusive thoughts or emotions and the consequences of the accompanying symptoms dissociation rendering them unable to remember specific information.
However, it is unclear whether this is due to an actual increase in identities, or simply that the psychiatric community has become more accepting of a high number of compartmentalized memory components.
Most identities are of ordinary people, though historical, fictional, mythical, celebrity and animal identities have been reported. Comorbid disorders can include substance abuseeating disordersanxietypost traumatic stress disorder PTSDand personality disorders.
Their conclusions about the empirical proof of DID were echoed by a second group, who still believed the diagnosis existed, but while the knowledge to date did not justify DID as a separate diagnosis, it also did not disprove its existence.
Both groups also report higher rates of physical and sexual abuse than the general population, and patients with BPD also score highly on measures of dissociation. It has been suggested that all the trauma-based and stress-related disorders be placed in one category that would include both DID and PTSD.
These central issues relating to the epidemiology of DID remain largely unaddressed despite several decades of research. Trauma model of mental disorders People diagnosed with DID often report that they have experienced severe physical and sexual abuseespecially during early to mid-childhood  although the accuracy of these reports has been disputed and others report an early loss, serious medical illness or other traumatic event.
What may be expressed as post-traumatic stress disorder in adults may become DID when occurring in children, possibly due to their greater use of imagination as a form of coping. Evidence is increasing that dissociative disorders are related both to a trauma history and to "specific neural mechanisms".
There is very little experimental evidence supporting the trauma-dissociation hypothesis, and no research showing that dissociation consistently links to long-term memory disruption. This behavior is enhanced by media portrayals of DID.
While proponents note that DID is accompanied by genuine suffering and the distressing symptoms, and can be diagnosed reliably using the DSM criteria, they are skeptical of the traumatic etiology suggested by proponents.
Such a memory could be used to make a false allegation of child sexual abuse. There is little agreement between those who see therapy as a cause and trauma as a cause.
Lower rates in other countries may be due to an artificially low recognition of the diagnosis. Conversely, if children are found to only develop DID after undergoing treatment it would challenge the traumagenic model.
While children have been diagnosed with DID before therapy, several were presented to clinicians by parents who were themselves diagnosed with DID; others were influenced by the appearance of DID in popular culture or due to a diagnosis of psychosis due to hearing voices—a symptom also found in DID.
No studies have looked for children with DID in the general population, and the single study that attempted to look for children with DID not already in therapy did so by examining siblings of those already in therapy for DID. An analysis of diagnosis of children reported in scientific publications, 44 case studies of single patients were found to be evenly distributed i.
The studies reporting the links often rely on self-report rather than independent corroborations, and these results may be worsened by selection and referral bias.
Most previous examples of "multiples" such as Chris Costner Sizemorewhose life was depicted in the book and film The Three Faces of Evedisclosed no history of child abuse.
It has also been found difficult to diagnose the disorder in the first place, due to there not being a universal agreement of the definition of dissociation. Specially designed interviews such as the SCID-D and personality assessment tools may be used in the evaluation as well. The DDIS can usually be administered in 30—45 minutes.
All are strongly intercorrelated and except the Mini-SCIDD, all incorporate absorptiona normal part of personality involving narrowing or broadening of attention. Tests such as the DES provide a quick method of screening subjects so that the more time-consuming structured clinical interview can be used in the group with high DES scores.
Depending on where the cutoff is set, people who would subsequently be diagnosed can be missed. An early recommended cutoff was A diagnosis of DID takes precedence over any other dissociative disorders. Distinguishing DID from malingering is a concern when financial or legal gains are an issue, and factitious disorder may also be considered if the person has a history of help or attention seeking.
Individuals who state that their symptoms are due to external spirits or entities entering their bodies are generally diagnosed with dissociative disorder not otherwise specified rather than DID due to the lack of identities or personality states.Depression is a common topic for research papers in psychology classes.
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