Dissociative Identity Disorder: Skepticsm decreases with information and education about Dissociative Disorders 

Many studies have shown the majority of both psychiatrists and clinical psychologists view the diagnosis of Dissociative Identity Disorder (Multiple Personality Disorder) as valid. As understanding of Dissociative Disorders increases world-wide, skepticism decreases.

Warwick Middleton: Australian psychiatrist

Transcript

Now when the [trauma and dissociation] unit first started, there were psychiatrists in the hospital that was established who had the sort of reactions that were talked about here this morning, with raised eyebrows and shaking of heads, like borderline hell had just moved in. In fact, it’s sort of interesting that by not attacking, by not being overly defensive, by being warm, inviting, encouraging dialogue, giving appropriate information, research material, articles, books, et cetera, if they were requested, but certainly never attacking anyone for being a disbeliever or having a different paradigm, it’s very interesting over the years just how many of those psychiatrists that were openly incredulous and dismissive, have become stalwart admittants to the unit.  In fact, I can remember one psychiatrist … this is going back more than a decade and a half, who rang me, at that stage he was a senior registrar … it says something about the ambivalence about this area, he rang me saying he doesn’t believe that DID exists, but nevertheless he has a patient with it that he’s like to refer.

Research (Newest articles first)

Leonard, D., Brann, S., & Tiller, J. (2005). Dissociative disorders: pathways to diagnosis, clinician attitudes and their impact. Australian and New Zealand journal of psychiatry, 39(10), 940-946.
Abstract
Results: Of the 250 clinicians, 21% reported experience with more than six cases on average of any one of the dissociative disorders, 38% with less than six, 42% with none; 55% regarded them as valid diagnoses, 35% dubiously valid and 10% invalid. Of the 55 patients, 76% reported delays in diagnosis (57%, ❤ years and 25%, <10 years) with adverse consequences in 64%; 80% had experienced sceptical or antagonistic attitudes from clinicians, rated as destructive by 48%. They were disabled (60% rated as <50% impaired) and were heavy consumers of health services (48% hospitalized, 68% <5 times). There was considerable comorbidity including moderate or severe depression (96%), self-harm (68%), suicide attempts (69%), panic disorder (53%), eating disorders (75%), substance abuse (25%), poor physical health (44%), major interpersonal (70%) and sexual problems (90%). Patients rated individual psychotherapy as the most helpful treatment (90%) but medications, such as antidepressants, were also valued (60%). Conclusions: Although over half of the responding Australian clinicians thought that dissociative disorders were valid, the rest were dubious about their validity with 10% believing them to be invalid. Only 21% had considerable experience with the disorders. These findings may relate to some of the difficulties perceived by patients, which included delays in diagnosis, suboptimal treatment and negative experiences with clinicians. http://www.tandfonline.com/doi/abs/10.1080/j.1440-1614.2005.01700.x

Somer, E. (2000). Israeli mental health professionals’ attitudes towards dissociative disorders, reported incidence and alternative diagnoses considered. Journal of trauma & dissociation, 1(1), 21-44.
Results: Years  in clinical  practice  (including postgraduate  and registrar  training)  did not  differ  between psychologists  (mean =  16.1 years, SD  =  9.68)  and psychiatrists  (mean =  18.8 years, SD  =  10.05). Overall, there  was  a  greater  tendency to believe  in the  existence  of  the  condition with 48 (55.8%) respondents  replying “Yes,”  and 32 (37.2%)  replying “No”  to the  reality of  DID. Five  (5.8%) participants  replied “unsure,”  and one  did not  respond to this  item. Excluding the  unsure responses  and one  missing value, a  chi-square  analysis  between psychologists  and psychiatrists for  this  item  showed a  significant  relationship between profession and belief  (chi-square  =  13.00, p  <  .001). Psychologists  showed a  greater  tendency to believe  in the  existence  of  DID  (23 yes, 3 no), while  the  slight  majority of  psychiatrists  did not  believe  in the  clinical  reality of  DID  (25 yes, 29 no).

Abstract Clinical diagnoses of dissociative disorders (DDs), including Dissociative Identity Disorder (DID), are controversial because there are mental health professionals in North America and elsewhere who are skeptical about whether these psychiatric disorders actually exist. This paper explores the attitudes of mental health professionals in Israel toward DDs and DID through a survey of 211 practicing clinicians (return rate of 39.5%). Of the sample, 95.5% scored at or above the point on a 5-point Likert scale measuring belief in the validity of DDs (m = 4.17, SD = 0.78); 84.5% declared at least a moderate belief in the validity of DID (M = 3.5, S.D. = 0.97). The average Israeli clinician surveyed had made 4.8 career-long DD diagnoses (S.D. = 18.06) and carried an average of 1.05 DD patients in his/her caseload (S.D. = 2.86). DID had a career-long diagnosis frequency of 0.14 patients per clinician (S.D. = 0.59) and was currently seen at a frequency of 0.03 cases per clinician (S.D. = 0.20). The five most frequently considered alternative diagnoses to DID in Israel were Borderline Personality Disorder (24%), Psychotic Disorder/Schizophrenia (23%), PTSD/Anxiety Disorder (10%), Malingering (8%) and Depressive Disorder (7%). The findings suggest that attitudes of Israeli clinicians are similar to those of North American clinicians despite the geographical and cultural differences between them. Full paper – https://www.researchgate.net/profile/Eli_Somer/publication/232909347_Israeli_Mental_Health_Professionals’_Attitudes_Towards_Dissociative_Disorders_Reported_Incidence_and_Alternative_Diagnoses_Considered/links/02e7e51cef1213f1df000000.pdf

Cormier, J. F., & Thelen, M. H. (1998). Professional skepticism of multiple personality disorder. Professional Psychology: Research and Practice, 29(2), 163.
Abstract
 If you saw a patient who appeared to have more than one personality, what diagnosis would you make? And how would you vary your clinical approach? Data from 425 respondents indicated that the majority of psychologists believed multiple personality disorder (MPD) to be a valid but rare clinical diagnosis. Respondents cited extreme child abuse as the foremost cause of MPD. Approximately one-half of all respondents believed that they had encountered a client with MPD, whereas less than one-third believed that they had encountered a client who feigned MPD. http://psycnet.apa.org/journals/pro/29/2/163/
Professional attitudes to Dissociative Identity Disorder (MPD) in Britain: More on treating DID where it doesn’t exist.  Paper presented at the 4th conference of the International Society for the Study of Dissociation-UK branch. J Mcintee. 1998. and

Davis, J.D. & Davis, M.L. (1997). The prevalence of dissociative disorders within the mental health services of a British urban district.Paper presented at the Fourth Conference of the International Society for the Study of Dissociation. Chester, UK, April 19-11.

Summarized by Somer, E. (2000) A recent survey conducted in Britain sought to test the prevailing view in the United Kingdom academic press that DID either did not exist or was fashionably over-diagnosed by gullible practitioners, influenced by ill-advised North American colleagues. The survey was designed to examine British psychologists’ and psychiatrists’ attitudes towards the identification and treatment of dissociative disorders (McIntee, 1998). Dissociative disorders had been encountered by 66% of respondents, of whom 14% attributed dissociation to iatrogenesis. The 965 British mental health professionals responding to the survey reported having seen a total of 3225 clients with DDs, 526 clients diagnosed as DID, and 596 clients with Dissociative Disorder–Not Otherwise Specified. The estimated life prevalence rates for a British research sample reported a year earlier were 15.2% for DDs in general and 5.7% for DID specifically, with clinical profiles resembling those described in the North American literature (Davis & Davis, 1997).
Hayes, J. A., & Mitchell, J. C. (1994). Mental health professionals’ skepticism about multiple personality disorder. Professional Psychology: Research and Practice, 25(4), 410.
Abstract
Three studies were conducted to investigate the nature of mental health professionals’ skepticism regarding multiple personality disorder (MPD). An initial pilot study was conducted to develop a psychometrically sound survey instrument. In Study 2, the results of a national survey of 207 mental health professionals supported the hypothesis that skepticism and knowledge about MPD are inversely related, r = –.33, p < .01, although the strength of this relationship varied among professions. Moderate to extreme skepticism was expressed by 24% of the sample. Results from Study 3 supported the hypotheses that MPD is diagnosed with less accuracy than is schizophrenia and that misdiagnosis of MPD is predicted by skepticism about MPD. Findings are related to literature pertaining to mental health professionals’ skepticism about MPD and consequential effects on treatment. http://psycnet.apa.org/journals/pro/25/4/410/

Dunn, G. E., Paolo, A. M., Ryan, J. J., & Van Fleet, J. N. (1994). Belief in the existence of multiple personality disorder among psychologists and psychiatrists. Journal of clinical psychology.
Abstract
Surveyed the attitudes of 664 psychologists and 456 psychiatrists with regard to the existence of dissociative and multiple personality disorders (MPDs). 97.5% of the Ss indicated that they believed in dissociative disorders, while 80% reported a belief in MPD. 12.3% did not believe in MPD, and 7.7% were undecided. Belief in MPD was related significantly to profession, age, and years of experience. Young Ss with less professional experience believed more in MPD than did older Ss. Ss who had worked with patients with MPD would tend to believe in the entity. http://psycnet.apa.org/psycinfo/1995-21368-001

Barton, C. (1994). Backstage in psychiatry: The multiple personality disorder controversy.
Abstract
Arguments about the existence of multiple personality disorder (MPD) are creating a professional dispute. Skepticism is manifested in literary as well as behavioral forms. The most widely cited recent skeptical paper is that of H. Merskey (see record 1992-31500-001). Merskey uses arguments that are sociological in nature but with little attention to empirical evidence. Merskey’s skepticism about MPD differs from skepticism in natural science. Proponents’ research is ignored rather than being subjected to critical examination and disproof through attempted replication. His skepticism appears largely based on challenges to the integrity of MPD patients and questions about the competence of therapists. http://psycnet.apa.org/psycinfo/1995-29438-001 Mersky’s response – and Barton’s response to it

Dell, P. F. (1988). Professional skepticism about multiple personality. The Journal of nervous and mental disease, 176(9), 528-531.
Abstract
Therapists who have treated patients with multiple personality disorder (MPD) were surveyed about professional skepticism regarding the existence of MPD. Of these therapists, 78% reported that they had encountered intense skepticism from fellow professionals. Much of this skepticism appears to be explainable in terms of a) the lengthy decline of psychiatry’s interest in dissociation, b) under appreciation of the prevalence of individuals with dissociative ability, and c) misconceptions about the natural clinical presentation of patients with MPD. These factors, however, could not explain the behavior of those skeptics who deliberately interfered with the clinical care of patients and who engaged in repeated acts of harassment against the patient and/or therapist. Half of the survey respondents reported that they had encountered these latter forms of extreme skepticism. http://journals.lww.com/jonmd/Abstract/1988/09000/Professional_Skepticism_about_Multiple.2.aspx


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