Dissociative identity disorder (DID), as a diagnosis, is controversial. People sometimes ask, is dissociative identity disorder real? While many healthcare professionals believe it to be genuine, to the point where it is listed in the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5) (the book used to guide all psychiatric diagnoses), other professionals feel it doesn't exist and should be removed from the DSM-5. According to a 1999 study, only 21% of board-certified American psychiatrists felt that there was strong evidence for DID's scientific validity and 58% of surveyed psychiatrists were either skeptical of the diagnosis or felt it should be removed from the DSM-5 altogether.
There are many arguments both for and against DID. This article will outline some of the dissociative identity disorder controversies.
IS DID Real? Are the Causes of DID Real?
In 2004, Piper and Merskey did an extensive literature review and in spite of some sources saying that up to 99% of people with DID report childhood abuse, they found:
- No proof that DID results from childhood trauma
- Consistent evidence that some proponents of DID likely cause the symptoms of DID through the treatment ("blatant iatrogenesis"); in other words, the diagnosis and treatment of dissociative identity disorder caused memories of childhood abuse.
The dissociative identity disorder debate here, is, if we cannot find a solid link between a diagnosis of DID and trauma, then what is the basis for these symptoms and can they be explained by other diagnoses (such as borderline personality disorder which has the symptom of identity disturbance as addressed in schema therapy)?
Dissociative Identity Disorder Controversy: Is a DID Diagnosis Valid?
The basis of this DID controversy is that first-person reports of dissociation based on existing diagnostic scales are invalid due to the crafting of said scales. It is argued that the way these scales are designed, increase false positives.
An example of one such question on a scale is, "I get so wrapped up in watching TV, reading, or playing a video game that I don't have any idea what's going on around me."
This statement, of course, would be true for many, if not most, people.
DID Debate: Can a Dissociative Identity Disorder Harm the Patient?
According to Dr. Gharaibeh MD, a psychiatrist,
"A DID diagnosis has been blamed for misdiagnosis of other entities, patient mismanagement, and inadequate treatment of depression. Even when DID is treated with the best of intentions, undesired negative effects may result from psychotherapy, and some patients experience worsening of symptoms and/or deterioration of functioning."
Is DID Fake? Do DID Proponents Have a Conflict of Interest?
Some healthcare professionals ask if dissociative identity disorder diagnosis proponents have a conflict of interest, such as monetary gain. People diagnosed with DID tend to have very long-term, intensive psychotherapy care and this can create an income of up to $20,000 per year per patient. This creates a great incentive to diagnose DID.
Should People Diagnosed with DID Try to Find Another Diagnosis?
While the debate around DID will continue, people who are concerned with their diagnosis may be best served by working with a treatment provider that they trust and/or getting a second opinion. People should also keep in mind that there is some medical evidence of the existence of dissociative identity disorder:
- In 2006, Vermetten et al found significant differences in amygdala and hippocampus volumes in people diagnosed with DID.
- Reinders et al (2003, 2006) also found blood flow differences in the brain that corresponded to specific personalities.
Full coverage of dissociative identity disorder controversies can be found here.