“Crazy” thoughts and feelings – Dissociative Identity Disorder and Psychotic spectrum symptoms

Can someone have both Schizophrenia & Dissociative Identity Disorder?
Yes, this is possible, or another psychotic or schizophrenia spectrum condition can exist with DID. It isn’t a particularly common combination (compared to, for example, Borderline Personality Disorder or an Anxiety Disorder existing alongside DID).

What are the key differences between Dissociative Identity Disorder and Schizophrenia?

Some people with DID find their symptoms are never confused with the psychotic symptoms found in Schizophrenia – but others may be misdiagnosed with Schizophrenia, or diagnosed only with Schizophrenia when DID is also present. Experiences like ‘hearing voices’, ‘seeing things which aren’t there’ (pseudo-hallincinations caused by flashbacks) can cause a lot of confusion.
The DSM-5 (full version, p297) gives some limited guidance on differences:

  • Individuals with dissociative identity disorder experience these [psychotic-like] symptoms as caused by alternate identities, do not have delusional explanations for the phenomena, and often describe the symptoms in a personified way (e.g., “I feel like someone else wants to cry with my eyes”).
  • Persecutory and derogatory internal voices in dissociative identity disorder associated with depressive symptoms may be misdiagnosed as major depression with psychotic features.
  • Chaotic identity change and acute intrusions that disrupt thought processes may be distinguished from brief psychotic disorder by the predominance of dissociative symptoms and amnesia for the episode, and diagnostic evaluation after cessation of the crisis can help confirm the diagnosis.

Dissociative Identity Disorder is also a dissociative disorder, meaning that symptoms are primarily dissociative in nature – even when it was known by the name Multiple Personality Disorder, DID was classified as a Dissociative Disorder; Schizophrenia is classified as a psychotic disorder, meaning in involves one or more of: delusions, hallucinations, disor­ganized thinking (speech), grossly disorganized or abnormal motor behavior (including catatonia), and negative symptoms (flat emotions or severe lack of will).

Survivors of organized or ritual abuse may have some highly unusual beliefs which are not caused by any kind of delusions or psychosis, but result from the highly unusual abuse they have survived – including abuse designed to discredit survivors who tell.

Elizabeth Howell explains:

Kluft reported that patients with DID endorse 8 of the first-rank Schneiderian symptoms (Schneider, 1959, as cited in Kluft, 1987a) that are considered pathognomonic of schizophrenia.
These symptoms are voices arguing, voices commenting on one’s action, influences playing on the body, thought withdrawal, thought insertion, made impulses, made feelings, and made volitional acts.
In DID, rather than as indications of schizophrenia, the hallucinated voices and the made actions are understood as due to the activities of a dissociative identity. The psychotic person is more likely to attach a delusional explanation, such as “The CIA has implanted a chip in my brain.” In contrast, the person with DID, although probably unaware of the source, often knows that these experiences are not normal and does not seek to explain them in a delusional way (Dell, 2009c). In addition, the person with DID—as opposed to someone who is psychotic—often has the ability to be in two states of mind at once: While the person experiences the self as having the “crazy” thought, the person is able to hold the tension and know that it is just that, a crazy thought.
Of course, this knowledge that one is having thoughts that others would consider crazy only tends to contribute to the highly dissociative person’s fear or belief that he or she is crazy!


The phenomena of full and partial dissociation are highly confusing to the person with DID as well as to those who notice them. Unlike someone who suffers primarily from depression or anxiety and who can label the problem, the person with DID generally suffers from amnesia about the very symptoms experienced and often cannot specfically identify the problem…
Understanding and Treating Dissociative Identity Disorder, Elizabeth Howell (2011)

CIA, Dissociative Identity Disorder and Ritual Abuse Survivors
While high profile organizations like the C.I.A. are often referred to by people who are experiencing psychotic symptoms (e.g., delusions of persecution), many people are unaware that the CIA has historically been involved in child abuse, including child abuse with the purpose of creating dissociative identity disorder. The involvement of the CIA in these human rights abuses is not a ‘conspiracy theory’ but is well documented, with hearings in the U.S. Senate held in the 1970s to investigate this, and other related abuse.
Karl Douglas Lehman and Ellen Lacter have produced guidelines to help clinicans differentiate between Schizophrenia and Dissociative Identity Disorder which may be helpful, see Ritual Abuse in the Twenty-First Century (2008) – chapter 4.

Alison Miller, a psychotherapist specializing in therapy for ritual abuse survivors, comments that that one lie about abuser’s power and knowledge (that children are told) is that “There is a microchip implanted in the survivor’s body that tells the abusers where s/he is and / or what s/he is thinking” Healing the Umimaginable, p122

Miller also points out that even if such as object was found, “that does not mean it is capable of collecting complex information and sending it back to abusers, or even sending them signals, for twenty or more years, as some survivors belief.” (p205)

Diagnostic and Screening Tools
A variety of different diagnostic and screening tools are available to help determine if a person has Schizophrenia or Dissociative Identity Disorder. Diagnostic interviews can give a definite diagnosis, and determine whether both or neither are present, for example the Structured Clinical Interview for Dissociative Disorders, or the Dissociative Disorder Interview Schedule, but these can only be carried out by clinicians (both involve a degree of observation).

Two screening tools which can be used to determine if a dissociative disorder is likely to be present are the SDQ-20 and the Dissociative Experiences Scale – both of which are mentioned in the Dissociative Identity Disorder Treatment guidelines for adults. Both of these questionnaires give a typical score for Dissociative Identity Disorder, Schizophrenia, Dissociative Disorder Not Otherwise Specified and other conditions – but they are actually intended to highlight of a clinical diagnostic interview is likely to be helpful rather than giving a specific diagnosis. Both questionnaires result in a single score, making it impossible to rule out or confirm a diagnosis of Schizophrenia in people likely to have Dissociative Identity Disorder.

Posttraumatic Stress Disorder awareness items in teal – teal lapel pin badge. silicone wristbands

Posttraumatic Stress Disorder awareness items in teal - teal lapel pin badge. silicone wristbands

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How childhood trauma could be mistaken for ADHD

Could this be ADHD, trauma, or both?
(please bear in mind that some children with ADHD do not have behavioural problems)

ACEs Too High


[Photo credit: woodleywonderworks, Flickr]

Dr. Nicole Brown’s quest to understand her misbehaving pediatric patients began with a hunch.

Brown was completing her residency at Johns Hopkins Hospital in Baltimore, when she realized that many of her low-income patients had been diagnosed with attention deficit/hyperactivity disorder (ADHD).

These children lived in households and neighborhoods where violence and relentless stress prevailed. Their parents found them hard to manage and teachers described them as disruptive or inattentive. Brown knew these behaviors as classic symptoms of ADHD, a brain disorder characterized by impulsivity, hyperactivity, and an inability to focus.

When Brown looked closely, though, she saw something else: trauma. Hyper-vigilance and dissociation, for example, could be mistaken for inattention. Impulsivity might be brought on by a stress response in overdrive.

“Despite our best efforts in referring them to behavioral therapy and starting them on stimulants, it was hard to get the symptoms under control,”…

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“Split” movie quiz – Dissociative Idenity Disorder – Fact versus Fiction

Thing you don’t find out from an Abnormal Psychology courses

Violence & Dissociative Identity Disorder – any link, or just stigma?
There’s no link between having DID or any other mental disorder and being violent or committing violent crimes. The only exception is Anti-Social Personality Disorder (and even this is an optional criteria), this disorder only rarely occurs in people with DID. Sources: Mental Illness and Violent Behavior: The Role of Dissociation (2017) in Statement on Split by ISST-D, Peterson, Skeem et al. (2014) in Mental illness not normally linked to crime, DSM-5 p659 ASPD criterion A.
Being a victim of violent crime – especially physical abuse/assault and sexual abuse or rape is extremely common in people with DID. Self-inflicted violence e.g., self-harm and suicide attempts occur in 40-60% of people with DID (source: DSM-5).
Stigma? Extremely common – e.g., this scientific article in a newspaper has a picture with a caption “psychopaths” – a term irrelevant to DID but suggesting violence and crime.
Now, to the “Split” movie Dissociative Identity Disorder quiz…

Click as many answers as you like for each question – correct answers go green, wrong answers go red. There’s no total score to worry about.

1. In Split, the character with Dissociative Identity Disorder is male. But is DID more common in men than women?
There’s no general agreement on this.
Correct – The DSM-5 refers to a small US study that shows 1.6% of men and 1.4% of women in the community have Dissociative Identity Disorder – but one small study isn’t enough to draw conclusions from. Previous research has often referred to Dissociative Identity Disorder as more common in women – for instance, when published over 20 years ago, the DSM-IV stated DID was diagnosed 3 to 9 times more frequently in women than in men (meaning women were believed to account for 75-90% of adults with DID). Both agree that the gender balance is fairly equal in adolescents/children.
More women than men have DID, despite the fact that most fictional movies portray people with DID as men. The DSM-5 gives a rate of 1.6% of men in the general population, compared to 1.4% of women – but this is a small U.S. study, and the numbers are fairly similar. The DSM-IV claimed far more women than men had DID, but the DSM-5 does not.
No, more women have DID.
2. Dissociative Identity Disorder belongs in which category of mental disorders?
Dissociative Disorders
Although previous called Multiple Personality Disorder, DID is a Dissociative Disorder. Some people with DID also have personality disorders, some do not.
Personality Disorders
Although previous called Multiple Personality Disorder, DID is a Dissociative Disorder. Some people with DID also have personality disorders, some do not.
It used to be a personality disorder, but has been a dissociative disorder for a long time now.
Although previous called Multiple Personality Disorder, DID is a Dissociative Disorder. Some people with DID also have personality disorders, some do not.
Mood Disorders
Mood disorders involve unusually depressed or manic moods and include depression and bipolar disorders. They don’t involve rapid changes in emotions like those found when someone changes to an alternate personality. DID is sometimes misdiagnosed as bipolar 2 disorder (which Carrie Fisher had). Mood disorders may be diagnosed in addition to Dissociative Identity Disorder.
Dissociative Identity Disorder is in its own category.
Wrong – dissociative disorder involves symptoms of all the other dissociative disorders, including Dissociative Amnesia (which may include Fugues – unexplained travel combined with an identity change), Depersonalization/Derealization (feeling ‘not yourself’ or like the world is unreal). Other Specified Dissociative Disorder is an extremely similar condition to DID but doesn’t feature as much in movies.
Schizophrenia and Psychotic Disorders
Wrong – those disorders involve breaks with reality, for example delusions and being unable to tell what is and is not real. It’s uncommon to have this kind of disorder along with Dissociative Identity Disorder. Schizophrenia and Psychotic Disorders have medication licensed specifically for them, Dissociative Disorders do not – although medications like anti-depressants, including those licensed for Posttraumatic Stress Disorders, may help.
3. In Split, the character of Kevin develops Dissociative Identity Disorder as a young child to cope with abuse. DID can only develop if someone was abused as a child… fact or fiction?
Fiction, Split is just a movie. Nobody really knows why any mental disorder develops.
This is true for many mental disorders, but not all. Trauma-related disorders like Posttraumatic Stress Disorder and Dissociative Identity Disorder only develop as a result of trauma. DID cannot be inherited, but a family history makes a person more at risk of developing it after repeated early trauma. Dissociative Identity Disorder can only be caused by multiple traumas in early childhood – however, child abuse is only one type of childhood trauma.
Wrong – any form of repeated, prolonged childhood traumas can cause DID. Other examples include prolonged and distressing medical treatments. Source: DSM-5.
No, but it is the reason most people develop DID
Correct – Any form of repeated, prolonged childhood traumas can cause DID – but abuse isn’t the only kind of trauma. Other examples include prolonged and distressing medical treatments or witnessing violence. The overwhelming majority of people with DID report being abused multiple times in childhood, often over many years, but a memory of trauma isn’t needed for diagnosis. Source: DSM5. The Three Faces of Eve (which is based on a true story, and continues in 3 books) involved no abuse but many traumas.
4. In Split, the therapist refers to a case of someone with Dissociative Identity Disorder whose sight was restored after she went blind – by re-growing her optical nerve, and claims that people without DID can’t do this: could this actually be true?
No, both the explanation and the case mentioned are fiction.
It’s a real case, although highly unusual. The explanation given is wrong.
No, the case is real — but the explanation is fiction.
This condition does exist – both in people with DID and in people without DID: this is a case of blindness that a physical cause can’t be found to explain. It is the diagnosis of Functional Neurological Symptom Disorder (FND, alternatively called Conversion Disorder, and has been named Disssociative Sensory Loss – code F44-6 – by the World Health Organization. Source: DSM-5, ICD-10. The symptom involving blindness has several older names: psychogenic blindness, and hysterical blindness – articles about both can be found on google scholar. Why would someone lose their vision after trauma or severe stress?
Traumatic experiences can cause the mind to “shut down” a part of the body by refusing to transmit sensory or other information to or from it – it can be seen as the mind’s way to protect itself from the unbearable. Similar conditions involve paralysis, deafness, tremors, unexplained non-epileptic seizures (PNES), and some of the person’s body being numb to pain. People with DID often have physiological differences between alter personalities – this is called “physiological variability” – greater difference than would be found in a person without DID – but these differences aren’t as great as between different people. Examples include alters with different glucose levels in diabetics with DID, significant blood pressure changes and vision changes, right or left-handedness depending on the alter currently in control, different medication responses and allergies – but not changing hair color, height, etc. Dissociative Identity Disorder also does not involve superhuman self-healing powers. Souce: Dissociative Identity Disorder Treatment Guidelines for Adults (2011), p121. Does this transient blindness/psychological cause of blindness have anything to do with Dissociative Identity Disorder?
Well, physical symptoms or conditions – particularly those which are medically unexplained are unusually common in people with Dissociative Identity Disorder – and Functional Neurological Disorder an example of one such condition. They are so common that DID expert Dr Ellert Nijenhuis & colleagues found you could screen for DID just by asking about certain physical symptoms. They used historical and current medical records to devise and check for these symptoms, and produced a DID screening tool called the Somatoform Dissociation Questionnaire. It’s one of two self-assessment screening tools mentioned in the Dissociative Identity Disorder treatment guidelines for Adults, and can be used to check whether it’s worthwhile for a full structured interview to be done for Dissociative Disorders. It can reliability tell people with DID apart from those with Schizophrenia, Bipolar Disorder or Posttraumatic Stress Disorder – three of the most common misdiagnosis for people with DID.
To sum it up: people with or without DID can suddenly go blind, or be able to see again, including as a direct result of exposure to or resolving extreme stress or trauma – and certain physical health problems are far more common in people with DID. Trauma can affect both the body and the mind. See links to case studies at the end of the question.
Yes, people some people with Dissociative Identity Disorder have physical or biological abilities far outside the range of what is physically possible in people without DID.
5. True or False: people with Dissociative Identity Disorder rarely have more than a dozen alter personalities – unlike in the film “Split”, where the person has over 20.
False, some people do have over 20 alter personalities. It’s not highly unusual to have so many.
Even back in the 1990s, research showed that around 50% of people with Dissociative Identity Disorder had 10 or more alter personalities. Source: DSM-IV. Alter personalities can roughly be classed as “host” or “Apparently Normal” parts (e.g., Kevin in “Split”), or “Emotional Parts” who are created to cope with the effects of trauma (e.g., the others). New alter personalities can form at any age once DID is already present – either to handle new responsibilities in daily life or new trauma, so the maximum number doesn’t have a fixed limit. People with over 100 alter personalities are known as having polyfragmented DID, and typically have a very severe abuse history – this isn’t a separate diagnosis or untreatable. Best-selling author and mental health advocate Truddi Chase had 92 alters, who she called ‘The Troops’, her interviews with Oprah and her movie Voices Within: The Lives of Truddi Chase can be found on youtube. The Three Faces of Eve was based on a real person who later turned out to have 22 personalities – the film ends before this was known about her.
There used to be a lot of emphasis on how many alter personalities there were in people with DID but research no longer focuses much on this; it was not found to be a major factor in assessing the functioning of someone with Dissociative Identity Disorder or to require major differences in treatment.
No, it’s not possible to have that many alter personalities – and it’s definitely not possible to hold down a job or be “high functioning” in any way if someone has over 20 alter personalities.
The number of alter personalities doesn’t relate to how well a person copes in daily life – that’s a common myth. Many people do have a large number of alter personalities – keeping the awareness and memories of trauma “compartmentalized” in the minds of many alter personalities can actually mean the part handling everyday life can do so without having to deal with frequent flashbacks and trauma reminders day after day – although this isn’t true of everyone. Working through the trauma in treatment should be done at a manageble pace to avoid a sudden “flood” of shared trauma memories destabilizing someone (as explained in the Dissociative Identity Disorder treatment guidelines published by the International Society for the Study of Trauma and Dissociation).
6. People with Dissociative Identity Disorder cannot communicate mentally with alter personalities, like the character in “Split” does – instead they have to write notes for each other – otherwise they won’t know anything about what the other alter personalities did while in control… fact or fiction?
While some form of amnesia is required for a diagnosis of Dissociative Identity Disorder, total amnesia between alter personalities for everyday life is not – this is a common myth about DID. Being able to communicate mentally between one another – at least between some alters is not uncommon. Being able to see/hear/remember some or much of what took place when a different alter was in charge is also possible in people with DID – this known as co-consciousness. Amnesia can be one-way or two-way some alter personalities may know things the host or others don’t. (Source: DSM-5) Some people are always co-conscious, other people find they are not even after several years of good treatment.
Fiction, everyone with DID can do this
Fiction, some people can and some can’t: there’s no general rule about this.
Correct – While some amnesia is required for a diagnosis of Dissociative Identity Disorder, total amnesia between alter personalities is not – this is a common myth about DID. Being able to communicate mentally between one another – or being able to see/hear/remember some or much of what took place when a different alter was in charge is known as co-consciousness. Some people are always co-conscious, other people find they are not even after several years of good treatment. The amnesia required for a Dissociative Identity Disorder diagnosis wasn’t introduced until the 1990s, and may be about  “significant personal information” (e.g., your name, age, address, or major life events) – this needs to happen often enough to affect everyday life or cause distress. There are 3 types of amnesia mentioned in the DSM-5. Recurrent gaps in the recall of everyday events, important personal information, and/ or traumatic events that are inconsistent with ordinary forgetting.
7. Dissociative Identity Disorder always causes either significant distress, or impaired functioning in one or more major area of life (e.g., social life, work, family life)… true or false?
False, this isn’t part of assessing whether someone has DID
This is the 5 diagnostic criterion for Dissociative Identity Disorder- all of which must be met. Source: DSM-5 criterion C. If someone with DID heals enough trauma and develops a great enough range of skills to handle daily life without significant problems in any area of life – and they aren’t distressed by the dissociative symptoms, then they may still have alter personalities and dissociation. But it won’t be called as a ‘mental disorder’.
False, social life is irrelevant in assessing for DID
Social life is one major area of life considered important in psychiatric assessments – and this criterion is worded in the same way whether you are assessing for DID, Personality Disorders, Schizophrenia, Depression, OCD, etc. A social life and social support from others is also known to increase a person’s resilience to life stressors and future traumas. But having problems with only your social life and no dissociative symptoms won’t lead to a diagnosis of DID or any other Dissociative Disorder.
8. Dissociative Identity Disorder is the only psychiatric/mental disorder involving a person being traumatized by abuse/trauma they have no memory of… fact or fiction?
First of all, the ‘person with DID’ refers to the whole person, including the memories of their alter personalities (alter personalities are not considered separate “people” in psychiatry or psychology) – so while the part of the person who is in charge most of the time may or may not remember abuse/trauma, another part/alter personalities will hold those memories and will never have forgotten them. Dissociative Identity Disorder trauma memories are encoded correctly in the brain – the problem is only with retrieving them, something that happens automatically over time or when a particular set of circumstances occurs to bring back the memory. Secondly, the following disorders also involve periods of ‘forgetting’ traumatic memories:
– Dissociative Amnesia – previously called psychogenic amnesia and well documented among combat troops
– Posttraumatic Stress Disorder – an optional criteria of PTSD is forgetting a significant part of the trauma
– People without a specific mental disorder who were abused or traumatized as children, particularly physically or sexually, are known to spontaneous recall such a memory
Not true – you don’t need to have DID (or any other mental disorder) to spontanously remember a traumatic event from the past – and the traumatic event may or may not be abuse. Even a memory witnessing a traumatic event can be ‘forgotten’ but later corroborated. See end of quiz for examples
9. “Split” shows a switch to an animal / animal-like alter personality called the Beast – this has got to be nonsense – right? And can alter personalities have a different gender to the person’s physical body?
It’s nonsense. Alter personalities are part of a person and are always human – but they can have any gender, or may be genderless (bear in mind that alters developing from traumatized young children or babies are developing from a mind that may not yet understand gender so see themselves as genderless).
Some alter personalities do feel/believe they are animals or a different gender to their physical body
Surprisingly these types of alters gets a passing mention in the 10 page description of DID found in the DSM-5 – it’s linked to ‘Cultural influence’ –
“Similarly, in settings where normative possession is common (e.g., rural areas in the developing world, among certain religious groups in the United States and Europe), the fragmented identities may take the form of possessing spirits, deities, demons, animals, or mythical figures.” Smith (1989) describes a 70 year-old Native American with many alter personalities which see themselves as animals or spirits – unsurprisingly they aren’t evil serial killers either. The logic behind Dissociative Identity Disorder is that alter personalities form as a mental escape or separation from the unbearable – and they begin to form at a very early age (normally before 8 or 9 years old). So alter personalities are limited by a young child’s imagination or needs (and later on in life, by a teenager or an adult’s). So it is possible for an alter personality to regard themselves as an animal – even being unaware they exist in a physically human body. What they cannot do is physically change a human body to an animal one – or physically change gender – so that part of the movie “Split” is fiction/artistic license/metaphorical etc. Abused children have sometimes being treated “like an animal” – literally – for example being fed pet food or chained up outside with dogs, or being called “It” (like Dave Pelzer, in A Child Called It) – so an alter personality may simply assume they are (or prefer to be) in the form of an animal, spirit or some other non-human form. Depersonalization within DID can involve feeling disconnected from your body – as if it (or part of it) isn’t actually yours even when logically you can see it is. All types of alter personality exist as part of the same human mind, and a human body (even though some may “deny” or “disavow” this).
10. James McAvoy was excellent at acting the role of a person with Dissociative Identity Disorder. Surely a really talented actor, or maybe just someone who actually knew a person with Dissociative Identity Disorder would be able to fake the disorder well enough to fool even professionals… wouldn’t they?
It would take a lot of skill, but it’s possible. It might even be harder to fool professionals without training in Dissociative Disorders – because they aren’t as likely to realise just how hidden and subtle the changes can be. It would be easy to memorise answers to typical questions too, in order to get diagnosed.
It’s not absolutely impossible to be sure that a diagnostic error would never ben made – but it would be very difficult indeed, especially compared to many other mental disorders. Non-clinical staff like lecturers or academics who never meet people with dissociative disorders during their research would be most likely to get it wrong: and to miss many genuine cases.
Fooling a clinican would be extremely unlikely to happen for several reasons -particularly those trained in Dissociative Disorders, because – Actors and psychology students have already taken part in research to determine whether they can pretend to have Dissociative Identity Disorder and be incorrectly diagnosed as a result. Psychology students – even when coached and educated about DID didn’t match the DID patients (e.g., Palermo, 2012, Brand et al, 2014. Professional actors also failed in separate research – despite psychology training about DID and dissociation – they had no problem with the acting, but their acting couldn’t mimic the EEG changes (e.g., Hopper, Ciorciari, Johnson, Spencer & Sergejew, 2001) or changes in the brain between alter personalities of someone with Dissociative Identity Disorder on a brain scan, nor could fantasy-prone people pretending to have DID, e.g., Schlumpf et al (2014), Brand & Chasson (2015), Reinders et al (2012). The physical structure of the brain didn’t change – but the blood flow in different regions of the brain changed in a consistently way in people with Dissociative Identity Disorder as they switched to an alter personality – changes in the actors simply didn’t match. Physical structure is also different: in particular the amygdala and hippocampus sections of the brain have a smaller volume in people with DID. See below the quiz for more reasons and research

Further links and research for questions

Question 4 – blindness with alters that can see and blindness caused by psychological trauma – videos & cases
Real cases of transient blindness, with and without DID: Blind woman who switched personalities could suddenly see (2013), / Sight and blindness in the same person: original research, 2015 (PMID: 26468893 DOI: 10.1002/pchj.109) / 2007 summary. Diana, with her blind alter personality Margo, and her sighted alter personality Corey.

A case study in Eastern Congo, Africa, in 2011 found this kind of dissociative and transitory blindness among women traumatized by extreme sexual violence.15 year old girl in Ethiopia

Somatoform Dissociation Questionnaire (scroll down for the SDQ-20)

Question 8- Example cases of amnesia for a major trauma include:

  • Witnessing a murder, recalled years later, allowing police to identify the previously unidentified victim
  • Cases of child sexual abuse witnessed by other adults or victims who they never forgot
  • a significant percentage of cases of sexual abuse or rape which involved hospital treatment at the time but couldn’t be recalled later (LM Williams, 1995)

  • See also: The Recovered Memory Project

  • Dissociative Amnesia – Soldiers witnessing another soldier’s trauma: which the soldier denies all memory of – previously called psychogenic amnesia – is well documented among combat troops (see DSM-5 p300, and Trauma-induced dissociative amnesia in World War I combat soldiers (van der Hart, Brown, & Graafland, 1999)

  • Holocaust survivors who were held in concentration camps having not a single memory of it (link above)
  • Dissociative Amnesia – a case of losing all memory of finding the body of a loved one after their sudden death (video, may be distressing to watch)
  • Posttraumatic Stress Disorder – an optional criteria of PTSD is forgetting a “significant part of the trauma” typically due to “dissociative amnesia”(source: DSM-5, PTSD criteria D.1)
  • People without a specific mental disorder who were abused or traumatized as children, particularly physically or sexually, are known to spontaneous recall such a memory
  • Historical examples from literature also exist, including the Parisian opera Nina (1786) by Dalayrac and Marsollier, in which the heroine forgets seeing her lover apparantley killed in a duel and still waits for him daily – then won’t accept it is him when he does later appear.
  • Somatoform Dissociation Questionnaire (scroll down for the SDQ-20) – physical problems common in people with DID

Question 9 – Animal alters

Smith (1989) describes a 70 year-old Native American with many alter personalities which see themselves as animals or spirits – unsurprisingly they aren’t evil serial killers either.
See also: Alters in DID

Question 10 – Why it’s very difficult to pretend to have Dissociative Identity Disorder to clinicians – besides biological/physical testing

  • As it mentions in “Split”, people with Dissociative Identity Disorder spend an average of 7 years in the mental health system before being diagnosed with DID – typically have have a series of misdiagnosis. If many clinicians have neither training or experience diagnosing any dissociative disorders, they aren’t likely to give the diagnosis to someone realistically acting out the symptoms either. But the actors may be diagnosed with schizophrenia, psychotic disorders, borderline personality disorder, or bipolar disorder by mistake – and possibly medicated for them. Even if the actor told a clinician they believed they had Dissociative Identity Disorder/multiple personalities that often won’t lead them to asking relevant questions for diagnosis – they may assume you just want to be a “special” or “interesting” case, or maybe you should be assessed for histronic personality disorder (which involves dramatic, exaggerated behavior). Not until the 2013 publishing of the DSM-5 could people’s self-reporting of DID symptoms count (self-reporting Depresson, Bipolar symtpoms etc, was fine though) – the person had to switch to an alter personality in front of clinical staff (reports and descriptions from partners were ignored). Having an alter personality turn up for the assessment didn’t usually because it wasn’t a “switch” being observed.People professional diagnosed and be told by friends or family that “you don’t have that” or “nobody has that” because they don’t present symptoms that fit the stereotype, or because they don’t “match” movies about real people with DID like Sybil. Check out Truddi Chase’s interviews on Oprah, and see if you can spot her DID symptoms… of course, she might not actually “switch” to an alter personality when on camera.
  • Dissociative Identity Disorder (like other mental health conditions) shouldn’t be diagnosed just be observing someone – which is what happens in the movie Primal Fear – the character of Aaron Stampler was acted so brilliantly that Dissociative Disorders specialist Dr Bethany Brand commented on how realistic it was to watch… but clinical assessment has a set of well-validated screening tools and diagnostic interviews available for clinicians which can be used to check for faking DID.
  • Dissociative Identity Disorder is a hidden disorder – like all the other dissociative disorders, unless symptoms are continually obvious (which only applies to about 4% of people with it), or the person has a short period of more obvious symptoms (as shown in the movie “Split”) – there won’t be much to act: it’s behavior-based symptoms are subtle, and most clinicians don’t ask about dissociative symptoms or amnesia
  • It’s not difficult to memorize answers to standard questionnaires – but the clinician might never give you a questionnaire, and if they do then questionnaires aren’t diagnostic tools. Questionnaires (e.g., the Dissociative Experiences Scale) are screening tools – they simply signal to the clinician that a clinical interview for dissociative disorders would be appropriate/helpful – they give a range of scores in which DID is highly unlikely, or fairly likely to be present in many people with those scores.
  • Supposing you get to a clinical interview, and the clinician is knowledgeable about Dissociative Disorders. There’s only two well established clinical interviews, but one has over 100 questions – without a “total score” to aim for, and the other takes around 90 minutes and the scoring information (i.e., the range of ‘correct’ answers isn’t publically available). Supposing the actor did manage to get a set of appropriate answers (there are many different combinations, since DID isn’t the same for everyone), those answers would need to be memorized and repeated at the same time as making subtle movements which indicate some dissociation is taking place – at the same time as not actually looking like you are trying to remember anything. To practice the interview questions you’d need get a copy first, which you have to buy for and they are only given to people who can prove their clinical qualifications in the first place, academic qualifications alone aren’t enough!
  • Part of assessing for any mental disorder – including Dissociative Identity Disorder – involves taking into account current and recent life circumstances. If this acting is being done to fake a disorder in order to avoid a criminal conviction, this will mean a “forensic” assessment gets added – and DID is hardly ever counted as a legal defense anyway (in contrast to psychotic disorders, which are accepted as a legal defense if several enough) – not exactly like the movie Primal Fear then. Motivated faking of Dissociative Identity Disorder or truly believing you have it when you don’t (“simulated DID”) both have many indicators, e.g., (e.g., Thomas, 2008) that would be difficult to fake.
  • Note: Some poor “teaching” about Dissociative Identity Disorder involves role playing alters, which is mistaking DID for a primarily behavior-based disorder, students may find their memory poor as they act different roles – which is called “state-dependent memory” and exists in non-DID people: it’s easier to remember events when you are in the same emotional state as when the event happened. After, they write up their “experiment” using their memory of it (none will have amnesia for everyday events like many people with DID do, so this won’t be a problem), and they will never have these “symptoms” again… because of course, the symptoms were acted rather than genuine. Faking DID behaviors won’t lead to the students going home and not recognizing their room mates, not remembering the year they were born, or find themselves covered in blood because an alter personality self-harmed without their knowledge. They won’t “come round” several hours later and not know whether they remembered to eat dinner – or whether an alter personality remembered and ate it for them. This “role playing” is actually an example of stigma: it would be totally insulting to “act out” a more familiar disorder like depression by “looking sad and lethargic” for a while, but DID is often treated without compassion and as a “fun” or “entertaining” practical exercise. Even worse, this leads to the assumption that if only someone with DID could “snap out of it” and “behave normally” the whole condition would go away – which doesn’t work for any mental disorder – because it’s not a choice.

Further Information about Dissociative Identity Disorder

Statement on Split by the International Society for the Study of Trauma and Dissociation (ISST-D, 2017)

Separating Fact from Fiction: An Empirical Examination of Six Myths About Dissociative Identity Disorder – Brand (2016)

Dissociative Disorders: An Overview of Assessment, Phenomonology and Treatment A 10 page Dissociative Identity Disorder and Dissociative Disorders summary from the Psychiatric Times, comparing DID with Borderline Personality Disorder, Schizophrenia and Bipolar

Dissociative Identity Disorder Treatment Guidelines for Adults (ISST-D, 2011) – search this 80 page document for everything you ever wanted to know about DID

Dissociative Identity Disorder in the DSM-5 – 10 pages including the diagnostic criteria (APA, 2013, from p580 via google books preview)

Jeanne Fery: A sixteenth-century case of dissociative identity disorder

Know someone you think is faking having Dissociative Identity Disorder? Read Holly Gray’s excellent blog

Split movie quiz - Dissociative Identity Disorder Fact versus Fiction

Thanksgiving Day, aka “Forced Family Fun”

Since Thanksgiving is very soon, & many of you feel forced to deal with your narcissistic families on the day, I thought I would write a post for you in that position, Dear Readers …

Source: Thanksgiving Day, aka “Forced Family Fun”