The dissociative identity disorder diagnosis controversy

The divisible identity turnover diagnosis controversyDissociative Identity overturn (DID), formerly known as Multiple Personality Disorder (MPD), has been astray effd and analyze over the years. Although Dissociative Identity Disorder was formally accepted by the DSM-IV as a valid psychiatrical diagnosis, yearning debate ab out(a) its lustiness is still common. thither argon both prefatory positions that dominate the controversy of DID. There are some who conceptualise that it is a valid diagnosis. Proponents of DID argue that those who resist to diagnose their long-sufferings with DID and fail to recognize the distemper are non well trained. magic spell others argue that DID is non a valid psychiatric diagnosis. These tribe argue that DID is shitd by direct individuals who look continuously searches for the right healer until they receive the diagnosis that they cherished. In auxiliary to that, these people look at that DID is an iatrogenic pheno manpoweron br ought on by bumbling therapists through hypnosis and suggestions.For those who argue that DID is a valid diagnosis they point out that the diagnosis of Dissociative Identity Disorder is extremely convoluted. One of the reasons that its composite plant to diagnose is because of how difficult it is to several(predicate)iate from mevery other(prenominal) other syndromes. In amplification to that, DID can even coexist with more(prenominal) familiar and less debatable syndromes. In 1984, Coons stated that DID can be confused with other dissociative disorderlinesss such as psychogenic amnesia and fugue, and depersonalization disorder. Furthermore, DID can overly be confused with atypical dissociative disorder experience by those who were in prisoner or hostage piazzas and dissociates from the stress such as physical and emotional abuse that they endure caused by their captors. Since phobias, mood swings and change reactions like pseudo seizures, paralysis, and blindness are c ommon with anxiety, affective, and somatoform disorder they whitethorn as well as co-exist with multiple constitution disorder. In order to obtain more certainty that a affected role has DID, Coons suggested that information from external sources such as family members, friends, coworkers, and hospital staff is measurable. When asking these people, a clinician should ask about evidence of genius changes, persistent lying, use of third person, wadwriting changes, and many others deadly signs that may provide evidence of DID (Coons, 1984). In addition to Coons, in a survey conducted by Horevitz and Braun (1984), they anchor that DID can co-exist with minimal personality. They studied 93 enduring roles with confirmed diagnoses of DID. During the contemplate they were simply if to evaluate 33 of the 93 illustrations. They tack that 23 of the 33 or 70% of their sample also qualified for the diagnosis of borderline personality (Horevitz Braun 1984). Similar to the studi es conducted by Horevitz and Braun, and Coons, clary, Burstin, and Carpenter concluded that DID has a lot in common with borderline personality. They drew their conclusions from 11 patients who were poor and referred through usual agencies and womens shelter. On their study, Clary et al. noted the difference amongst their findings and Richard Klufts (1982) findings. Kluft found borderline characteristics in completely 22.8% of his 70 subjects. 45% of them were describe as neurotic mixtures and 32% were described as hysterical-depressive. Clary et al. assumed that their results were antithetic from Kluft because Klufts patients were from a private psychoanalytical practice. Because of this, their functioning is better because of the demands intensive psychoanalytic psychotherapy entails (Clary, Burstin, Carpenter, 1984).Proponents of DID like hum North, Jo-Ellyn Ryall, Daniel Ricci, and Richard Wetzel point out documented physiologic differences between personalities of patient s with DID. These claims were then back up by the argument that these symptoms could not be replicated by normal people or professional actors. This is because, there are distinctive patterns among the different personalities that a patient with DID has. These differences can be detected through the positron liberation tomography (PET) scans, evoked potentials, voice prints, optical acuity, eye muscle balance, visual field size, galvanic skin response, electroencephalographic patterns, electromyography, and cerebral blood stream (North et al., 1993, pg. 29).Proponents argue that DID patients are quiet, unassuming, and shy individuals who do not seek public attention. fit to Kluft (1985), DID patients try to disguise their conditions because they are worried about the reactions that theyre passage to gravel from reluctant therapists. In different studies conducted by Kluft, he found multiple times the reluctance that DID patients feel when seeing a therapist. In one of his stud ies, he found that only 40% of patients with DID showed penetrative hints of the disorder go 40% showed no overt signs at all. In that study he found that the diagnosis of DID was an inverse relationship to how clear the symptoms were in the patient. During this study he also found that multiples who enter treatment do because of affective, psychotic-like, or somatoform symptoms as opposed to classical DID symptoms. Since the presentation of the disorder is oftentimes subtle, Kluft points out that it is important for clinicians to work very hard to elicit a bill compatible with DID. Similar to Coons, Kluft specifically mentioned that its important for clinicians to use indirect inquiries for patients who show the symptoms of DID (Kluft, 1984). In 1986 he found that 50% of DID patients withheld evidence of DID during their starting line assessment, and 90% said that at one point in their lives they tried and true to hide the manifestations of DID. Kluft also found that there a re some cases where the symptoms of DID are not voluntarily provided to the therapist because patients are unaware that they obtain the disorder (Kluft, 1986). In spite of a lack of consensus that DID is a valid psychiatric disorder, proponents of DID, like Kluft, have divided DID into subtypes. Later Kluft (1991) described the typology of DID presentation that includes the spare-time activity types Classic MPD, latent MPD, posttraumatic MPD, extremely complex of fragmented MPD, Epochal or sequential MPD, isomorphic MPD, coconscious MPD, possessioniform MPD, reincarnation/mediumistic MPD, atypical MPD, secret MPD, ostensible complex number companionship MPD, covert MPD, phenocopy MPD, somatoform MPD, Orphan symptom MPD, switch-dominated MPD, ad hoc MPD, modular MPD, quasi-roleplaying MPD, and pseudo-false verifying MPD (North et. al, 1993, pg. 30).Another person who believes that DID is a valid psychiatric disorder is brad Foote. Foote (1999) wrote a paper that features why DID can easily be ridiculous for hysterical phenomena. One of the main critiques that other people have is that DID does not occur naturally. Instead, its symptoms are a modern version of hysteria. In this view, many believe that patients may create or report dissociative symptoms both intentionally and unintentionally in order to assume the sick role. Opponents believe that this sick role is advantageous because of the attention that they get from friends, family, and their therapist. In addition to that, some proponents believe that the therapist has a big influence on the patients pathology and thus contri unlesses to this phenomenon. According to this view, patients did not have any symptoms of DID present earlier to seeing a therapist. On the other hand, those who treat DID patients argue that 1. There is a naturally occurring presentation of DID, prior to therapist suggestions 2. Patients do not embrace the DID diagnosis go for involvemently, and in fact usually fight at least as hard to reject as, for extremely ego-dystonic 3. DID symptoms do not disappear when ignored and 4. The disorder actually begins in childhood, in the context of overwhelming trauma, and there could not possibly be caused by the great(p) therapist together with the patient (Foote, 1999, pg. 321). Foote describes that for a typical DID patient, ineffectiveness takes tush in a severe level. He states that it is common for a DID patient to have a long history of abuse, usually including sexual abuse. When it comes to analyse DID, Foote explains a situation in which a typical DID patient entrust find herself in. If the therapists bias that the DID patient is creating her symptoms to seek attention, this bias will only be confirmed by all of the drama and attention that the patient will have. Whether or not the patient does anything spectacular depends on the therapist. Subsequently, if the patient is chideing to a skeptical listener, the patient will feel powerless and will caus e her to give up, or become hysterical and horrific in her communications in order to explain to her therapist her symptoms. Furthermore, if the therapist has a strong bias that switching from one personality to another is feigned, there are no data that could falsify this statement. If the patients switch is subtle the observer would think that there is no big deal and it doesnt come along like the patient has a different personality. Similarly, if the patient has a prominent switch the therapist would believe that her actions are exaggerated and obviously unreal. With this said, however, Foote wanted to clarify that DID diagnosis is not immune from factitious presentations for the purpose of attention-seeking. However, scepticism can become a barrier to the possibility of the diagnosis to be perceived. To conclude, Foote wanted to point out that first, DID by its nature is unavoidably dramatic and that this causes clinicians to be unconvinced before they have ever seen a DID p atient. Because of this, he encourages clinicians to be open-minded and be aware of how complicated DID can be. He believes that if a clinician takes their time to patiently immerse him/herself in the world of DID, they will discover the possibilities of DID that are not readily available superficially. Second, Foote points out that its important for clinicians to, Hopefully, we can call upon our own internal resources of calmness and confidence that if a story is true it will ultimately be heard, and proceed to enunciate accordingly (pg. 342).According to Frank Putnam (1996), There are three basic criticism when it comes to the validity of DID. The first one is that DID is an iatrogenic disorder caused by the shrink. Second, critics say that DID is produced by the media. Finally, critics say that DID case numbers are increase exponentially over the years. For the first argument on DID macrocosm caused by a psychiatrist, Putnam points out that there are at least dickens clinical studies that have shown that there are no distinct differences between those who are diagnosed with DID and was inured with or without hypnosis. Also, many patients who have never been treated using hypnosis was diagnosed with DID. This shows that the accusation that the misuse of hypnosis is responsible for the disorder is not accurate. Second, by looking at decades worth of research on the media effects on behavior, Putnam says that it is clear that exposure to specific media is not a sure cause of a certain behavior. He points out that the portrayal of violence in the media is more common than the depiction of DID. Yet, critics say that the small amount DID portrayals in the media is significantly responsible for the increase in diagnosed cases. Finally regarding DID cases increasing exponentially Putnam says that its common for critics to inflate their numbers without any evidence supporting their figures. According to him, after plotting the numbers of published cases of DID h e found that they have change magnitude but not as dramatic as critics make it sound. In fact, over the kindred period of time other disorders such as Lyme disease, obsessive-compulsive disorder, and chronic fatigue syndrome have shown an equal or rapid increase in published cases compared to DID. These results reflect the results of basic advancement in the medical field. Disorders increase in published cases may be imputable to the new discoveries of symptoms that used to be unrelated. As new symptoms are found to be related to certain disorders, the more the physicians can identify the condition. Ultimately, Putnam believes that DID meets the standards of theme validity criterion, criterion-related validity, and construct validity considered necessary for the validity of a psychiatric diagnosis (pg. 263).One of the controversial topics about DID and its diagnosis is that hypnosis elicit DID. Richard Kluft, a Clinical of Professor of Psychiatry in Temple University School of euphony believes that hypnosis or suggestion may be the reason some patients have climb up personalities. However, he believes that iatrogenesis or hypnosis do not explain DID. While Putnam (1986) did not detect and differences in clinical presentation, symptoms, or past history between patients who were hypnotised and those who werent. Furthermore, Ross et al. (1989) conducted a study where they studied 236 patients who were diagnosed with DID. They found that only a third of these patients had been hypnotized prior to being actually diagnosed with DID. In addition to this study, Ross conducted another study where he compared DID patients of psychiatrists who specialize in DID and patients of psychiatrists who did not specialize in this disorder. They concluded that DID is not iatrogenic. The idea of iatrogenesis has been continuously disputed. The study that Ross et al. (1989) found compelling evidence that shows that DID is a real(a) disorder with unchanging core features wit h compelling evidence.Nicholas Spanos, a Professor of Psychology at Ottawas Carelton University conducted both experiments which explores DID. He argues that DID patients are not passive victims. Instead, they are patients who do things to purposefully be diagnosed with the disorder. He also argued that therapists assist these patients achieve their goals. The therapists provide encouragement, information, and governance for the different identities. For his first experiment in 1984, he had forty-eight undergrad volunteers as his subjects. They were asked to role-play an accuse multiple murder named Henry or Betty whose lawyer decided to enter a not guilty plea. They were told that a psychiatrist would interview them and might even use hypnosis. If hypnosis was used they were asked to also role-play being hypnotized. The subjects were not told anything about DID. There were three possible conditions that eight men and eight women were randomly assigned to. In the first condition, the subjects were asked if the felt the same thing as Harry or Betty or if they felt any different. In the reciprocal ohm condition, subjects were told that they had complex personalities but hypnosis would allow the therapist to get behind the wall that hid their inner thoughts from awareness. Furthermore, the hypnotist would be able to talk to their other personality under hypnosis. In the third, which was the control group, subjects were told that personality was complex and included walled-off thoughts and feelings. Spanos also administered a five-item sentence completion and a differential test to all subjects (it included all their different roles, where a second personality was enacted). After the psychiatrist told the subjects their personality, they asked the same four questions to each subject. The responses were rated by judges who didnt know the subjects treatment groups. The results showed that 81% of the subjects who were asked if they felt the same thing as harry o r Betty or are they different and 31% of subjects in hidden-part treatment select a new name. 70% of those subjects who adopted a new name had deuce different identities. 63% of subjects in the hypnotic treatments displayed spontaneous amnesia. While, none of the control subjects used a different name or had amnesia. In his discussion Spanos makes four points. First, only the subjects who were hypnotized used another name, reported two different identities, and amnesia. Second, all but one subject who had multiple personalities admitted guilt on the second administration. Those who had no multiple personalities continuously denied guilt. Third, Spanos points out how easy it is to fake multiple personality even without the knowledge of DID. Finally, Spanos points out that multiple typically show secernate personalities. Spanos believes that the amnesia of his subjects was a strategic way to control the subjects ability to callback a memory in response to the situation at hand (Spa nos 1984).Another point that opponents want to make is that DID is well suited for providing patients a way to avoid being responsible for their actions. Kluft (1985) described some DID patients who honour their disorder. In hospital wards, other patients complain that DID patients avoid accountability and responsibility. DID may also be accounted for the failures that a person with DID wants to avoid facing. DID patients use this disorder as an excuse for their difficulties or failures to explain why they were in the situation that they were in. According to Bliss, another way that DID can be beneficial to others is that it shows an vent to express behaviors that are deemed unacceptable, such as sexual behaviors, physical aggressions, or substance abuse. An alternate personality may abuse substances or rape, while the host personality would never do such a thing. This fits the descriptions that alternate personalities are usually irresponsible and likes to act out with the host p ersonality as proper. Alternate personalities are also created to manage unpleasant emotions that the patient wants to avoid. Specific emotions are assigned to a personality as a way to avoid having to acknowledge strong or painful emotions. (Kluft, 1985).Since the case of Eve Black became famous Thigpen and Cleckley wrote a paper where they showed concern for the pandemic of DID cases. There were thousands of patients who travelled thousands of miles to see different therapists until they received the diagnosis that they wanted. non only that, but they go through great lengths such as talking on the phone in different voices, sending photographs of different selves, and writing letters with different handwritings for every paragraph. When it comes to these people, these desperate actions would not break down until they were diagnosed with DID. Another category of patients wrongly diagnoses with DID were attention-seeking hysterics who are affected by the labeling process. While, the hold up category that they described are groups of individuals who arent satisfied with their self-concept so they use disassociation to allow the unacceptable aspects of their personalities to be expressed (Thigpen Cleckley, 1984).Proponents of DID assert that DID is a genuine disorder that has a valid diagnosis, whereas skeptics argue that DID is an iatrogenic or faked condition. These two different arguments may both be persuasive but neither of them does not answer the question of the validity of DID. It is important to evaluate these arguments to view the extent of the diagnosis of DID. Current knowledge of the clinical phenomenology of DID cannot be considered as either proof or disproof that DID is a valid diagnostic entity. Kluft calls for active research rather than fruitless debate (pg. 3). Future studies on DID will have many opportunities to address the challenges that both proponents and opponents of DID diagnosis validity pose.