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Dissociative Identity Disorder (DID), as defined by the American Psychiatric Association’s Diagnostic and Statistical Manual of Mental Disorders (DSM), is a psychiatric diagnosis that describes a condition in which a single person displays multiple distinct identities or personalities (known as alter egos or alters), each with its own pattern of perceiving and interacting with the environment. The diagnosis requires that at least two personalities routinely take control of the individual’s behavior with an associated memory loss that goes beyond normal forgetfulness; in addition, symptoms cannot be due to drug use or medical condition. Earlier versions of the DSM named the condition multiple personality disorder (MPD), and the term is still used by the ICD-10.
There is a great deal of controversy surrounding the topic. There are many commonly disputed points about DID. These viewpoints critical of DID can be quite varied, with some taking the position that DID does not actually exist as a valid medical diagnosis, and others who think that DID may exist but is either always or usually an adverse side effect of therapy. DID diagnoses appear to be almost entirely confined to the North American continent[1][2][3], adding to the possibility that DID may not be a legitimate diagnosis.
DID is a controversial diagnosis and condition, with much of the literature on DID being generated and published in North America, to the extent that it was regarded as a phenomenon confined to that continent.[1][2][3] Even within North American psychiatrists there is a lack of consensus regarding the validity of DID.[4][5] Practitioners who do accept DID as a valid disorder have produced an extensive literature with some of the more recent papers originating outside North America. Criticism of the diagnosis continues, with Piper and Merskey describing it as a culture-bound and often iatrogenic condition which they believe is in decline.[3][6] There is considerable controversy over the validity of the Multiple personality profile as a diagnosis. Unlike the more empirically verifiable mood and personality disorders, dissociation is primarily subjective for both the patient and the treatment provider. The relationship between dissociation and multiple personality creates conflict regarding the MPD diagnosis. While other disorders require a certain amount of subjective interpretation, those disorders more readily present generally accepted, objective symptoms. The controversial nature of the dissociation hypothesis is shown quite clearly by the manner in which the American Psychiatric Association’s Diagnostic and Statistical Manual of Mental Disorders (DSM) has addressed, and re-dressed, the categorization over the years.
The second edition of the DSM referred to this diagnostic profile as Multiple Personality Disorder. The third edition grouped Multiple Personality Disorder in with the other four major dissociative disorders. The current edition, the DSM-IV-TR, categorizes the disorder as Dissociative Identity Disorder. The ICD-10 (International Statistical Classification of Diseases and Related Health Problems) continues to list the condition as Multiple Personality Disorder.
Paris[7] in a review offered three possible causes for the sudden increase in people diagnosed with MPD/DID:
Paris believes that the first possible cause is the most likely.
The debate over the validity of this condition, whether as a clinical diagnosis, a symptomatic presentation, a subjective misrepresentation on the part of the patient, or a case of unconscious collusion on the part of the patient and the professional is considerable. Unlike other diagnostic categorizations, there is very little in the way of objective, quantifiable evidence for describing the disorder.
The main points of disagreement are these:
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