Sexual Abuse and DID – Judith Machree

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Many therapists believe that extreme sexual abuse is the cause of DID in children and teenagers. There may be some truth to this judiththeory but many psychiatrists are skeptical about this claim. There is no scientific proof that sex abuse causes DID. There are no longitudinal studies on DID that could answer many questions about this profound disorder, including its causes. Reliving memories and experiencing the emotional responses, known as abreaction, doesn’t seem to heal the patient. This would suggest that sexual abuse may not be the cause since the therapeutic procedure isn’t healing the patient’s memories or history. Without a cure, it is very difficult to pinpoint the cause.

Author Judith Machree,(pictured left), herself an alleged former multiple and victim of childhood sexual abuse, claims otherwise. She cites a number of examples that alerted her to the fact that she was a multiple. These are some examples:

  1. After Machree married a supportive man she claims kept her on “an even keel”, she became more aware of her confusion and breaks with reality. She offers an odd example “I could park my car and go into the mall and not be able to find my car at all. I had no idea where I parked it.” If that’s a legitimate example of DID then I might have reason to worry: I forget where I have parked my car on a regular basis. I have spent up to a minute or two searching for it. I don’t see that as a sign of trauma.
  2. Machree cited a major depressive episode she had after her 17-year-old son left to join the military as a symptom of her DID. I doubt that claim. Many people have major depressive episodes, including when a family member leaves for an extended time period. It seems extreme, but as Machree explained, she was very close to her son and was quite dependent on him.
  3.  Her therapist suspected she had been abused because she had several gaps in her memory about her father. I don’t know what she refers to as gaps. Does this mean she cannot remember years of interacting with her parent? Neither can most people. I have a general idea of my relationship with my parents over the years and some specific memories associated with them, but I certainly cannot recall in detail most of my interactions with them.
  4.  As with most DID stories, Machree claims “the things that happened to me happened at such an early age.” Actually, those who believe in the phenomenon of DID claim that DID can occur at all ages in life, from early childhood to adulthood. Some people even claim that DID can be inherited. Ergo, children may be born with the disorder and it isn’t the result of childhood trauma.

Was Machree a victim of childhood sexual abuse? Who knows? Many women are, so that is entirely possible. Did she develop the extremely rare phenomenon known as dissociative identity disorder as a result? I find that hard to believe. Her story is so familiar it is practically an echo of all the published documentation of people’s experiences with DID. I have only read about one woman who claimed she was born with the condition. I have not read yet about people who developed DID in their teen years or in adulthood but this development is now identified in the DSM-5. Now that this information has been published, I expect that many people will suddenly come forward with stories of developing DID in their teens and later years. Trends often develop from suggestions about various disorders that are published in psychiatric manuals and journals.

 

 

 

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Multiple Personality Disorder (Hysterical Dissociative Disorder) and the DSM-II

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DSM I (Diagnostic & Statistical Manual of Mental Disorders, Version I) was created after WWI to provide a framework for labeling post-war psychiatric causalities. DSM II was written after WWII for the same purpose. Vibration-is-lifeThe texts were written in the USA by American psychiatrists. The International Code of Diseases (ICD) at that time through its present 9th edition has adopted these terms. MPD was listed as Hysterical Dissociative Disorder. As of the publication of the DSM-IV, psychiatric terminology distinguished two disorders that were once labelled ‘hysteria’: somatoform disorder and dissociative disorder.Patients with hysteria often experienced what has been termed as the Cassandra Effect. In Greek literature, Cassandra was a woman whom Apollo fell in love with and bestowed upon her the gift of prophecy. Cassandra1_jpegWhen she rebuffed his advances, he cursed her with the predicament of not being believed. Hysteria had been a favourite term with Victorian Era psychiatrists, especially that of Sigmund Freud. Hysteria was strictly a female phenomenon that included faintness, nervousness, sexual desire, insomnia, fluid retention, heaviness in the abdomen, and many other symptoms. One physician catalogued seventy-five pages of symptoms; by the time he was done, even a sneezing fit could fit the diagnosis. Doctors thought that stresses of modern life caused women to develop faulty reproductive tracts (a wandering uterus).

Josef Breuer – Anna O.
Anna O. (Berta Pappenheim) was a patient of Breuer’s in the early 20th century. He diagnosed Anna with hysteria due to symptoms that included “severe cough, Anna_Oparalysis of the extremities on the right side of her body, and disturbances of vision, hearing, and speech, as well as hallucination and loss of consciousness.” Breuer observed that she experienced ‘absences‘, a change of personality accompanied by confusion Breuer decided that Bertha Pappenheim‘s illness was caused by her father’s death. He died on 5 April 1881. At the time she became “rigid” and did not eat for days. Breuer’s treatment included force-feeding and chloral injections. .

He described Anna’s behaviour as follows:

She had two completely separate states of consciousness which alternated quite often and suddenly, and in the course of her illness became more and more distinct. In the one state she was sad and apprehensive, but relatively normal. In the other state she had hallucinations and “misbehaved”, that is, she swore, threw pillows at people.

Breuer thought she was deranged and hoped she would die to end her suffering. However, Anna disappointed him: she recovered and led a productive life. Anna’s symptoms fitted the definition of what was known at that time as “split personality.” 

In the DSM-II hysteria dissociative disorder was a minor condition in the manual. It lacked its own code number. The DSM-III gave “Dissociative Disorders” its own section. Experts decided which disorders should be listed in DSM-IV. Skeptics disagreed that MPD existed. Instead they concluded that patients believed they had more than one personality. The goal of therapy wasn’t integration but helping patients to overcome the belief that they had other personalities.Accordingly the name was changed to DID, dissociative identity disorder in the DSM-5.

What I don’t comprehend is how a patient would believe s/he had multiple personalities in the first flockplace, thereby needing to be cured of this delusion. Who puts the idea into the patient’s head? If anything, multiples typically argue against the notion that they possess alters and initially refuse to accept the diagnosis and integration since they believe it isn’t needed. Joan Francis Casey, in her text Flock: The Autobiography of a Multiple Personality” demonstrated great resistance in therapy about the diagnosis, to the point where she angered her doctor. Doctors who refute the diagnosis of MPD haven’t addressed this issue to the best of my knowledge.

 

Multiple Personality Disorder and the DSM-III

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3facesofeve1980 saw the revision of the DSM-II by the American Psychiatric Association. Several changes were made to the publication in the DSM-III concerning different disorders. One of the changes in the DSM-III was a separate category for the dissociative disorders. This gave considerable credence to the disorder. Of course it must be remembered that this was the time when Sybil was still fresh in people’s minds. Also around that time, Christine Sizemore, the “Eve” in “The Three Faces of Eve“, released a second publication about her experience with multiplicity. It had the unique perspective of being written in the first person by an integrated person who had suffered and been healed from the disorder.Sybil and The Minds of Billy Milligan soon followed, a “true” third person account, first as a text, then as a film, about a man who raped three women and used multiplicity as a legal defense during his trial.

In spite of multiple personality disorder’s inclusion in the DSM-III psychiatrists worldwide argued against its validity. At that time, MPD was almost completely an American phenomenon. It was very seldom reported by European physicians. It was and remains, an almost strictly a female phenomenon, with women being diagnosed as multiples approximately 8 times more often than men. Is that due to gender prejudice in the psychiatric system? Consider there is a listing in the DSM-5 for Hysteria, a disorder that defines women who display abnormal behaviour due to various stressors.

Since the publication of the Eve, Sybil and Milligan books, sybilalong with the inclusion of multiplicity in the DSM-III, there was a virtual explosion in the publication of psychiatric journals, books, biographical accounts, of accounts about patients with MPD. In 1980 there were a number of landmark publications about the disorder including E. L. Bliss’ study of fourteen patients, P. M. Coons systematic information about making a diagnosis, G. B. Greaves review article, B, G. Braun’s treatment recommendations and S. S. Marmer psychoanalytic study.  In 1989, Frank W. Putnam of the National Institutes of Mental Health published “Diagnosis and Treatment of Multiple Personality Disorder”. In 1989 Colin A. Ross, a researcher, published “Multiple Personality Disorder: Diagnosis, Clinical Features, and Treatment”.

In 1994 the DSM-IV renamed MPD as Dissociative Identity Disorder (DID) and the publication of Guidelines for Treating Dissociative Identity Disorder In Adults” by the International Society for the Study of Dissociation. Screening instruments, diagnostic instruments, and a mental status exam were developed. There is increasing information to the general public. Yet the debate involving the existence of Dissociative Identity Disorder and Multiple Personality Disorder continues.
Fmo4FCdU5umEFakK2vaySzk2c5s (1)The evolving theory of thought about DID, that the patient needs to be cured of his or her belief that s/he possesses varying mental fragments, makes little sense to me personally. I wonder where the patient developed the idea that s/he was more than one person. If this diagnosis was given by a clinician who believes in MPD, but another clinician who does not insists the patient suffers from DID, who is right?

Problems with Assessment of DID/MPD

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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 640px-Dissociative_identity_disorderinformation 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 dalia faceborn 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:

  1. It is almost strictly a North American phenomenon – MPD is diagnosed more frequently in NA than anywhere else in the world.
  2. Females are diagnosed 3 times more often than males.
  3. It became extremely popular in psychiatry after the sybilrelease 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.
  4. Diagnosis dropped considerably into the 1980s when the disorder was called into question for inclusion in the DSM-IV-TR.
  5. 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.
  6. There is no scientific methodology to prove the existence of MPD/DID.
  7. 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.
  8. MPD can be co-morbid with another disorder and therefore be difficult to assess.
  9. Psychiatrists have manufactured the existence of alternate personalities in patients.This is known as iatrogonesis.
  10. There is no such thing as several people within one body and one brain.
  11. No longitudinal studies have been conducted.
  12. No epidemiological studies have been conducted.
  13. 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, 640px-Dissociative_identity_disorderthough 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.
  14. DID/MPD has been diagnosed based on memory, a poor assessment tool.
  15. Only a small cluster of clinicians accept and use the diagnosis.

 

 

 

 

 

Causes

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Identifying causes is a major problem with diagnosing DID and this is one of many reasons why the inclusion and categorization of MPD/DID is an ongoing issue in the DSM-V. One reason is that there is no general consensus as picto what causes the disorder. There are debates but no scientific proof. There are no longitudinal studies. There are no epidemiological studies. There is no in-depth research on case studies. Diagnosis is dependent upon:

  1. Memory – a poor methodology at best
  2. Comparison of symptoms between case studies.
  3. Suspicion exists as to whether doctors themselves create alters through hypnotherapy and other methods (Iatrogenesis  or  brought forth by the healer).
  4. New discovery that DID development is possible after childhood
  5. prevalence rates across cultures and populations
  6. DID in children may partly result from a strong imagination used in coping skills. In adults however, DID may present as PTSD (post-traumatic stress disorder).


Possible causes:

  1. Trauma – sexual and physical abuse appear to occur frequently in these individuals The accuracy of these reports are disputed by professionals, witnessesParentsDaughterAug1931 and families.
  2. Other causes – early loss, serious medical illness or other traumatic event
  3. Lack of comfort by at least one parent or guardian during ongoing abuse. Individuals who have a chance to process the abuse and turn to a “safe” adult after
    abusive episodes seldom develop DID. Those who do not have this option frequently develop DID. However this too is called into question. How does the therapist know whether a traumatized individual would have potentially
    developed DID when this disorder doesn’t occur?
  4. Possible genetic connection. However, the gene theory hasn’t and cannot be proven. It is possible that forms of dissociation, such as dissociative fugue or amnesia, may be present in immediate or extended family members although this isn’t always the case.

Dr. Susan Taylor, a psychiatrist and expert in MPD (is there such a thing as an expert?) offers the explanation
that the higher self recognizes when a situation occurs that shouldn’t. That self acknowledges that “this is not right. I really shouldn’t do open-uri20120817-11927-1fr97jait. Just this once.” (She is referring to the splitting into another alter). Over time, the splitting becomes a kind of “belief system” and therefore ingrained. When that happens “we don’t remember the wisdom of the body and the wisdom of nature that told us, hey, don’t go down that road.” Inevitably, this leads to a “full-blown disease state.” Frankly this is one of the most comprehensive, if incomplete, explanations of the causes of multiplicity that I’ve ever heard.