DSM-V defines DID/MPD as the presence of two or more distinct identities or personality states” that alternate control of the individual’s behavior, accompanied by the inability to recall personal information beyond what is expected through normal forgetfulness. In each individual, the behaviour varies and the level of functioning can change from severely impaired to adequate. Individuals with DID may experience distress from both the symptoms of DID (intrusive thoughts or emotions) as well as the consequences of the accompanying symptoms (dissociation rendering them unable to remember specific information). Identities may be unaware of each other and compartmentalize knowledge and memories, resulting in chaotic personal lives.
The primary identity, which usually has the patient’s birth name, is the original core, or the first personality the individual possesses. It is hypothesized that the person is born whole then “splits” into several alters due to ongoing, extreme trauma. The core personality is “passive, dependent, guilty and depressed“. The alters are “out” or active more often than the primary or core personality. They are usually more aggressive and tend to hold complete memories, something the core lacks. DID is a major change in the DSM-5. Heretofore, DID was listed as MPD (Multiple Personality Disorder). MPD itself was fraught with controversy. Across continents there has been considerable debate as to whether MPD/DID even exists. There are a number of valid reasons for this:
- It is almost strictly a North American phenomenon – MPD is diagnosed more frequently in NA than anywhere else in the world.
- Females are diagnosed 3 times more often than males.
- It became extremely popular in psychiatry after the release of the boo Sybil, written by Flora Schreiber, and the release of the movie by the same name, Sybil, starring Sally Fields The story featured the supposed biography of Shirley Ardell Mason, although there has been much skepticism in the following decades about the validity of her account.
- Diagnosis dropped considerably into the 1980s when the disorder was called into question for inclusion in the DSM-IV-TR.
- MPD was linked with extreme sexual abuse but no scientific research has proven conclusively that this is true, particularly since a number of people who claim to have MPD have never been sexually or physically abused.
- There is no scientific methodology to prove the existence of MPD/DID.
- It is a disorder that many people have tried to fake for attention-seeking purposes and in some cases, for financial gain. This is co-morbid with a factitious disorder called malingering.
- MPD can be co-morbid with another disorder and therefore be difficult to assess.
- Psychiatrists have manufactured the existence of alternate personalities in patients.This is known as iatrogonesis.
- There is no such thing as several people within one body and one brain.
- No longitudinal studies have been conducted.
- No epidemiological studies have been conducted.
- Patients claim to have varying numbers of alters, yet there is no proof for these claims. The number of alters varies widely, with most patients identifying fewer than ten, though as many as 4,500 have been reported.The average number of alters has increased over the past few decades, from two or three to now an average of approximately 16.
- DID/MPD has been diagnosed based on memory, a poor assessment tool.
- Only a small cluster of clinicians accept and use the diagnosis.