“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

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


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.
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.
 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.
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.
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.
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.
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

7 Things to Avoid Saying to People with PTSD – and What To Say Instead


1. Get over it
Other variations on this are ‘why aren’t you better yet?’ and ‘But that was years ago.’ This is commonly said to abuse survivors, who often seem to be judged negatively compared to ‘wounded warriors’ who have PTSD as a result of military combat. Nobody chooses to have PTSD and it doesn’t disappear on demand, or when it becomes inconvenient for another person. Some people have PTSD for over 50 years despite working hard to heal, for others PTSD disappears by itself in a matter of months: even a trauma which seems ‘minor’ to another person, or happened decades ago can trigger severe PTSD symptoms. If a person could just ‘get over it’ in an instant, they would have already done so. Healing from PTSD doesn’t have a fixed timeframe, but support from others is known to help.

2. Everything happens for a reason
This view puts pressure on trauma survivors of find a positive reason behind their suffering, and can feel like the horror of the trauma is being minimized and was somehow ‘justified’. Some people do manage to find a positive outcome from the trauma, but it needs to be in their own time, and normally only happens late in the healing process. Healing PTSD involves dealing with loss, including the loss of a person’s former sense of safety, their former way of living (because PTSD symptoms often have a major impact on someone’s lifestyle), possibly losing their job or home, family, partner or friendships, and even sometimes their sense of identity. Would you say ‘everything happens for a reason’ to someone about bereavment? Then don’t suggest this to someone with PTSD.

3. It takes the same amount of effort to behappy as it does it be depressed
The exact opposite is true: lack of energy and lack of motivation are key symptoms of the depression, but a happy overall mood leaves you feeling energized and ready to face the world. Almost as bad is the phrase ‘If you act happy, you will become happy.’ The “persistent inability to experience positive emotions” affects many people with PTSD. Depression (and anxiety) often come as a result of PTSD, so rather than dealing with just one mental health disorder, a person can quickly find they are dealing with two or three. All people with PTSD regularly re-live the trauma, through flashbacks, nightmares or intrusive thoughts: with a mind that won’t stop replaying the worst moments of your life it would be hard to avoid feeling depressed. Severe depression makes it extremely difficult just to get out of bed, and willpower alone is not a known cure for depression. Disturbed sleep caused by PTSD or depression zaps energy levels further. Pressuring someone who is struggling to put on a fake smile or look on the ‘bright side’ in order to make you more comfortable isn’t helpful to them. Thinking or acting positively can help some people, but it can’t be forced. The pressure to ‘be positive’ can increase someone’s sense of isolation and any feelings of failure that depression brings.

4. All you need to do is…
‘You will feel better if you…’ is another version of this. There is no ‘quick fix’ or simple, easy solution to a complex condition like PTSD. It’s natural to want to help someone you care about, but unless you have been asked for advice, or have had a substantial battle with your own PTSD, resist any temptation you may have to offer solutions or well-being/mental health advice. Also be aware that news stories about new PTSD treatments are often misleading and not worth sharing: it is common to find out later they promote unavailable drugs, refer to clinical trials on mice rather than humans, involve a single study only, mention types of therapies which are not widely available, are only effective treatments for a different form of PTSD or PTSD caused by a different type of trauma – and they don’t mention risks (e.g., addiction and paranoia resulting from cannabis use, high drop-out rates, that it’s not advised for certain people, etc).
There is no single treatment or combination of treatments that everyone will respond to. Avoiding seeking professional help does not mean ‘not wanting to recover’ – it can simply be the result of the major PTSD symptom of ‘avoidance’ – which means avoiding anything that reminds the person of the trauma, including trauma professionals. Time does heal a proportion of people with PTSD, so a person’s mind may in fact already be healing by itself.

5. I know how you feel
It’s not possible to know exactly how another person feels, or what their thoughts are, unless you ask them. In PTSD symptoms often go from one extreme to another rapidly: from being emotionally numb to being anxious and ‘on edge’, or depressed and teary, then back again. One moment someone can be unable to stop talking about the trauma, and another time they will avoid conversations about PTSD or trauma and even the slightest reminder of it. Even after asking, you might not be aware of how strong particular feelings are.

6. Why didn’t you… during (or after) the trauma
You may want to keep your belief in a ‘just world’ where bad things don’t happen to good people – or if they do, good things later happen as a result – but trauma can affect anyone, and questioning someone’s actions or blaming them for a trauma is insensitive and judgemental. Unless you were in the same situation, at exactly the same time, and with the same personal history, you don’t know how you would reacted then – or how it would be impacting you now. Trauma responses are instinctive and biologically driven rather than logical decisions, and both ‘freeze’ responses and complying with (rather than resisting) a threatening person are common. Questioning someone’s actions, or rather reactions, during or after trauma is likely to feel like adding blame to someone who may not yet understand their own reactions.

7. It wasn’t that bad
Many people with PTSD will minimize their trauma, or may not mention the extent of what happened at that time (or shortly after the trauma). Some people have amnesia for some or most of the trauma’s details as well. This is the mind’s way of protecting itself from the full horror of the trauma, and the fact it could not be avoided or escaped. Don’t fall into the same trauma-related pattern of thinking and support their belief that ‘nothing really that bad happened’, ‘it was all my fault’ or ‘it was just an auto accident’, etc. The minimization (or even total denial) may later be followed by speaking out the reality of the trauma, which can sound contradictory, confusing and be judged as ‘exaggerating’ or ‘untrue’ because it doesn’t match the previous statements – or just because it sounds too horrible to accept. This pattern of minimizing (or denying) and then re-stating the trauma is not a measure of a person’s honesty, it can simply be the result of PTSD’s symptoms: either “distorted cognitions” about the trauma and/or an “inability to remember” major parts of the trauma (amnesia). A clearer picture of the trauma will emerge in time. If a person has developed PTSD that means the trauma has had a devastating impact and was too much for the mind to handle at the time. PTSD itself is a sign that the trauma was that bad, and even worse is the fact the person is reliving parts of the experience every day.

What To Say Instead
1. I’m here for you
But only say this if you really do mean it, over the longer term.

2. I’m sorry it happened to you
Nobody ‘deserves’ to be traumatized. Nobody makes that choice.

3. How can I help?

4. I can’t fix it, but I can listen.
Remember: listening doesn’t mean offering unsolicited advice.

5. Do you have the details of a helpline you can contact if you need to?
This shouldn’t be said as a way to avoid listening, but as a backup for when nobody is available or things are very hard. Helplines often offer text message or email help, some also offer online chat too.

What’s your favorite film about Dissociative Identity Disorder (MPD)?

Movies often given a distorted, stereotyped and stigmatized view of people with DID. But some movies – including those based on real people – are definitely worth watching. It’s been difficult to draw up a list of top movies to review: some movies feature high up on imdb’s list of movies tagged Dissociative Identity Disorder – others feature lower down but are highly rated, or Oscar winners. Wikipedia’s List of DID movies wasn’t as helpful – it contains spoilers and is fairly poor, which isn’t surprising given Wikipedia’s frequent intimidation of, bias against, and false information regarding DID.

10 Top Movies featuring Multiple Personalities (Dissociative Identity Disorder) http://traumadissociation.com/did-movies

New on our website are reviews of 10 popular movies featuring Dissociative Identity Disorder/Multiple Personalities.

Which are your favorite of these ten movies?

Read movie reviews, trivia, quotes and find out where to watch them on our website: http://traumadissociation.com/did-osdd/top-10-multiple-personality-did-movies.html

Vote for the best on imdb’s MPD list and DID movies lists, or using the poll below.

Which other movies would you recommend? Leave a comment below or add to the poll. All the chosen movies are full-length films, so the United States of Tara isn’t listed.

10 Male Sexual Assault Myths – Male Abuse Awareness Week

Survivor - to remain alive or in existence, to carry on despite hardships or trauma; persevere. Abuse - intentional harm or injury to another person, can be physical, sexual, and/or psychological. Dec 1- 8th Male Abuse Awareness Week. http://Facebook.com/TraumaAndDissociation

Male Abuse Awareness Week

~ May Trigger ~

Myth 1: Men can’t be raped or sexually assaulted.

Reality: Any man can be sexually assaulted or raped regardless of size, strength, appearance, age, occupation, race or sexual identity. The idea that men can’t be raped or sexually assaulted is linked to unrealistic beliefs that a ‘man’ should be able to defend himself against attack. Until 1997, under Australia’s Queensland Criminal Code, the offence of rape could only be committed against a woman.

Myth 2: Only gay men are sexually assaulted.

Reality: Any man can be raped, whether he identifies as straight, gay, bi, transgender or fluid sexuality. Rape is an act of force or coercion where someone’s personal choice is ignored. Just as being robbed does not tell you anything about someone’s sexuality, neither does rape. However, research does suggest that gay identifying men are more likely to be the subject of sexual violence.

Myth 3: It is gay men who sexually assault other men.

Reality: Most men who sexually assault other men identify themselves as straight.

Myth 4: Men cannot be sexually assaulted by women.

Reality: Although the majority of sexual assaults of men are committed by men, women do sexually assault men. Sexual assault is not always enacted through overwhelming physical force: it can involve emotional manipulation whereby a man can be coerced into sexual act out of fear of potential repercussions for his relationships, work, etc. The number of men identifying sexual abuse by a woman as a boy or young man has increased over the past few years. Ideas that men should always want sex with women and that as a young man you should feel lucky if you have sex with an older woman also make it difficult for a man to publicly name sexual assault by a woman.

Myth 5: Erection or ejaculation during sexual assault means you “really wanted it” or consented to it.

Reality: Erection or ejaculation are physiological responses that can be induced through manipulation and pressure on the prostate. Some people who commit sexual assault are aware how erections and ejaculations can confuse a man and this motivates them to manipulate their body and penis to the point of erections or ejaculation. They also can use this manipulation as a way to increase their feelings of control and to discourage reporting of the offence.

Myth 6: Most rapists are strangers.

Reality: Most men know the person who assaults them in some way. Often he/she is well known to them. They may be a friend, neighbour, boss or a relative, father, uncle, aunt, brother, sister, partner or ex partner. They may be a tradesperson or a professional e.g. doctor, teacher, psychiatrist, police officer, clergy or public servant.

Myth 7: Some people physically can’t commit rape.

Reality: A person’s physical strength, sex, sexual potency and sexual preference does not affect their ability to rape. Sexual assault can be committed through coercion or manipulation, by using fingers or objects such as sticks, marker pens or bottles. Rape is not all about physical force: young people and old people do sexually assault young and old people.

Myth 8: Men who sexually assault can’t control their sexuality.

Reality: People can control their sexual desires if they want to, however strong they might be. No “desire” gives anyone the right to violate and abuse another person. Far from being caused by lack of control, many sexual assaults are pre-planned and involve considerable abuse of power and control.

Myth 9: Men who have been sexually assaulted will go on to perpetrate sexual assault.

Reality: The majority of men who experience sexual violence do not perpetrate abuse or assault (they are horrified by such a suggestion). This is one of the most difficult myths for men: it can make men very reluctant to talk about experiences of rape or sexual abuse. There is no evidence to suggest an automatic route from experiencing abuse to going on to commit sexual offences. However, particular experiences (additional to sexual abuse) and models of masculinity are associated with an increased risk of someone perpetrating abuse.

Myth 10: Men who are raped are damaged and scarred for life.

Reality: Men can and do survive sexual assault, physically and emotionally, and go on to live full lives, enjoying rewarding relationships as friends, partners or parents. Although sexual assault can have a profound impact on men, they can and do find a way through and live the kind of life they would like. The media and many professional publications concentrate on stories of damage, recounting horror stories of what happened and the associated problems, without providing equal time to detail how men get on with their lives.


http://www.livingwell.org.au/information/unhelpful-myths-about-the-sexual-assault-and-rape-of-men/ (some changes made)

Help and Information


http://www.helpguide.org/articles/abuse/help-for-abused-men.htm Domestic violence information and help