Monday, September 8, 2008

Dissociative identity disorder - multiple personality disorder

Gleaves, D. (July 1996). "The sociocognitive model of dissociative identity disorder: a reexamination of the evidence". Psychological Bulletin 120 (1): 42–59. doi:10.1037/0033-2909.120.1.42. PMID 8711016. Gleaves states that the research on DID does not support the ideas that DID is a construct of either psychotherapy or the media (the sociocognitive model), but that there is a connection between DID and childhood trauma. “According to the sociocognitive model of dissociative identity disorder...DID is not a valid psychiatric disorder of posttraumatic origin; rather, it is a creation of psychotherapy and the media...In this article, the author reexamines the evidence for the model and concludes that it is based on numerous false assumptions about the psychopathology, assessment, and treatment of DID. Most recent research on the dissociative disorders does not support (and in fact disconfirms) the sociocognitive model, and many inferences drawn from previous research appear unwarranted. No reason exists to doubt the connection between DID and childhood trauma. Treatment recommendations that follow from the sociocognitive model may be harmful because they involve ignoring the posttraumatic symptomatology of persons with DID.

Brown, D; Frischholz E, Scheflin A. (1999). "Iatrogenic dissociative identity disorder - an evaluation of the scientific evidence". The Journal of Psychiatry and Law XXVII No. 3-4 (Fall-Winter 1999): 549–637. p. 604 - 605 “The problem with McHugh’s publications on MPD/DID, like those of Mersky, is that they are mere speculation. From deposition testimony in several cases, McHugh has made it clear that other than an occasional consultation, he has very little actual clinical experience with the ongoing treatment of MPD/DID patients and is generally unfamiliar with both the clinical features of MPD/DID and with what usually occurs in their treatment. This McHugh’s opinion is informed neither by actual in-depth clinical experience with contemporary MPD/DID patients nor by any scientific research on MPD. Furthermore, with regard to McHugh’s main hypothesis that hysterical behavior is implicated in DID iatrogenesis, Gleaves has shown that such phenomena are no more prevalent in DID than in any other psychiatric condition.”

“Conclusions...At present the scientific evidence is insufficient and inadequate to support plaintiffs' complaints that suggestive influences allegedly operative in psychotherapy can create a major psychiatric disorder like MPD per se...there is virtually no support for the unique contribution of hypnosis to the alleged iatrogenic creation of MPD in appropriately controlled research. "The Spanos socio-cognitive model reduces MPD to socially constructed role enactments. In this model, the often severe psychopathology associated with clinical MPD is minimized. Very recent studies suggest a possible neurobiological basis to MPD in at least certain MPD patients....It is clear that Spanos et al.'s 1985 conclusion that MPD is a role enactment based on their observation of role-playing subjects is based on circular logic: You ask a subject to pretend that he has alters and he complies; then you conclude that having alters is the product of role playing....Spanos's conclusion of the iatrogenic nature of MPD also suffers from an additional logical error. Even if it were true that MPD could be created iatrogenically, that does not prove that every case for noniatrogenic MPD cases....Situationally bound enactment of predefined secondary-personality roles presumes sufficient executive control to do it. Genuine MPD is defined in DSM as the loss of executive control...Genuine DID was defined in DSM-IV as the loss of a unified identity...Presumably none of Spanos's laboratory subjects suffered from a fundamental loss of a unified identity as a result of the experimental instructions....'''Genuine MPD is characterized by enduring alter-personality states that are defined by a relatively stable set of personality characteristics over time....The secondary-personality states reported by Spanos's subjects in the laboratory were very temporary role enactments....Spanos has seriously overgeneralized from the data of his 1985, 1986 and 1991 laboratory experiments that multiple personalities can be created in the laboratory.''' The more conservative interpretation merited by these data is that certain individuals with certain personality characteristics in a particular social context report temporary role enactments of different identities that are limited to the context of the experiment....Overall the Spanos data offer no evidence that either stable alter personalities or the range of clinical features typically associated with MPD can be created in the laboratory, and the data certainly offer no support whatsoever that MPD per se can be created through suggestive influences. At best, these data support the view that certain individuals in a high-demand context, and/or under extreme interview conditions wherein misinformation is systematically supplied, report temporary secondary-personality states....Overall, these data offer little evidence that the disorder MPD per se can be created through suggestive influences."

Ross, C.; Norton, G. & Fraser, G. (1989). "Evidence against the iatrogenesis of multiple personality disorder". Dissociation 2

“The authors present data which argue against the iatrogenesis of multiple personality disorder (MPD). Twenty-two cases reported by one Canadian psychiatrist, 23 cases reported by a.second Canadian psychiatrist, 48 cases seen by 44 American psychiatrists specializing in MPD, and 44 cases seen by 40 Canadian general psychiatrists without a special interest in MPD are compared. The Canadian general psychiatrists had seen an average of 2.2 cases of MPD, while the Americans had seen an average of 160. There were no differences between these groups on the diagnostic criteria, for MPD or the number of personalities identified. Specialists in. MPD are not influencing their patients to create an increased number of personalities or to endorse more diagnostic criteria. Exposure to hypnosis does not appear to influence the phenomenology of MPD.

Kluft, R.P. (1989). "Iatrogenic creation of new alter personalities". Dissociation 2 (2): 83–91.
“It would appear that the weight of available evidence, although far from conclusive, suggests quite strongly that the iatrogenesis of MPD de norm has yet to be demonstrated. Most of what would appear to be examples of the iatrogenic creation of new alters reflects the uncovering process of psychotherapy as it reaches already extant alters that were not immediately accessible for a variety of reasons, or the ongoing use by the patient of his or her characteristic ways of coping within the context of therapy.”

Braun, B.G. (1989). "Dissociation: Vol. 2, No. 2, p. 066-069: Iatrophilia and Iatrophobia in the diagnosis and treatment of MPD
“Iatrogenic induction of an alter personality by hypnotic or other means is highly unlikely, given the DSM-III-R criteria for defining an alter.”

Kluft, RP (2003). "Current Issues in Dissociative Identity Disorder". Bridging Eastern and Western Psychiatry 1 (1): 71–87.
“DID is emerging as a not uncommon consequence of overwhelming childhood events. It has been identified as occurring in many nations and is often very responsive to treatment.”

Pearson, M.L. (1997). "Childhood trauma, adult trauma, and dissociation". Dissociation 10 (1): 58–62.
"This paper studies the relationship among childhood trauma, recent trauma, and dissociation. Literature has suggested that early trauma may lead to dissociation. It was hypothesized that dissociation, including symptoms associated with Dissociative Identity Disorder (DID), would be more prevalent in those survivors of childhood abuse who were later traumatized in adulthood . Seventy-five female subjects completed a survey protocol. Subjects who experienced both early and recent trauma were more dissociative and endorsed more symptoms consistent with DID."

International Society for the Study of Trauma and Dissociation

Goettmann, B. A.; Greaves, B. G., Coons M. P. (1994). Multiple personality and dissociation, 1791-1992: a complete bibliography. Lutherville, MD: The Sidran Press, 85. ISBN 0-9629164-5-5.

blog on book “Switching Time” by Richard Baer

No comments: