Evidence that Dissociative Identity Disorder (Multiple Personality Disorder or MPD) is caused by Childhood Trauma

Conclusive evidence that Dissociative Identity Disorder (formerly called Multiple Personality Disorder or MPD) is caused by extensive childhood trauma and not iatrogenically (resulting from the activity of physicians) or socially. Individual identities have been shown to have clear physiological differences. These are only a few of the many studies available in professional journals and research books.

Child Abuse Wiki – Dissociative Identity Disorder

Dissociative identity disorder (formerly called Multiple Personality Disorder or MPD) is defined in the DSM-IV-TR as the presence of two or more personality states or distinct identities that repeatedly take control of one’s behavior. The patient has an inability to recall personal information. The extent of this lack of recall is too great to be explained by normal forgetfulness. The disorder cannot be due to the direct physical effects of a general medical condition or substance.

DID entails a failure to integrate certain aspects of memory, consciousness and identity. Patients experience frequent gaps in their memory for their personal history, past and present. Patients with DID report having severe physical and sexual abuse, especially during childhood. The reports of patients with DID are often validated by objective evidence.

Causes

The causes of dissociative identity disorder are theoretically linked with the interaction of overwhelming stress, traumatic antecedents, insufficient childhood nurturing, and an innate ability to dissociate memories or experiences from consciousness. Prolonged child abuse is frequently a factor, with a very high percentage of patients reporting documented abuse often confirmed by objective evidence. The Diagnostic and Statistical Manual of Mental Disorders states that patients with DID often report having a history of severe physical and sexual abuse. The reports of patients suffering from DID are “often confirmed by objective evidence,” and the DSM notes that the abusers in those situations may be inclined to “deny or distort” these acts. Research has consistently shown that DID is characterized by reports of extensive childhood trauma, usually child abuse. Dissociation is recognized as a symptomatic presentation in response to psychological trauma, extreme emotional stress, and in association with emotional dysregulation and borderline personality disorder. A study of 12 murderers established the connection between early severe abuse and DID. A recent psychobiological study shows that dissociative identity disorder (DID) sufferers’ “origins of their ailment stem more likely from trauma” than sociogenic or iatrogenic origins.

There is strong evidence that DID is not a culture bound phenomenon. Dissociative disorders have been found in more than a dozen countries. DID has been found in China and Turkey.

Physiological Evidence

Physiological evidence has provided additional evidence to back the existence of DID. One review of the literature found “physiologic and ocular differences across alter personalities.” Additional studies have been found showing optical differences in DID cases. One study found that “eight of the nine MPD subjects consistently manifested physiologically distinct alter personality states.” Other reviews have found additional physiological differences. Brain mapping has also found physiological differences in alternate personalities. A variety of psychiatric rating scales found that multiple personality is strongly related to childhood trauma rather than to an underlying electrophysiological dysfunction. Dissociative identity disorder patients have been found to have smaller hippocampal and amygdalar volumes than healthy subjects.  The involvement of the orbitalfrontal cortex has been proposed in the development of DID, suggesting a possible neurodevelopmental mechanism that would be responsible for the development of “multiple representations of self.” More recent research presents psychobiological evidence indicating actual physical alter states not found in controls.
with permission from http://childabusewiki.org/index.php?title=Dissociative_Identity_Disorder

Research Evidence showing a connection between Dissociative Identity Disorder and Trauma

Objective Documentation of Child Abuse and Dissociation in 12 Murderers With Dissociative Identity Disorder
“Signs and symptoms of dissociative identity disorder in childhood and adulthood were corroborated independently and from several sources in all 12 cases; objective evidence of severe abuse was obtained in 11 cases. The subjects had amnesia for most of the abuse and underreported it. Marked changes in writing style and/or signatures were documented in 10 cases. CONCLUSIONS: This study establishes, once and for all, the linkage between early severe abuse and dissociative identity disorder.”
http://ajp.psychiatryonline.org/doi/abs/10.1176/ajp.154.12.1703

Multiple personality disorder in The Netherlands: a clinical investigation of 71 patients.
The presenting characteristics of the patients showed a striking resemblance to those in several large North American series. Patients had spent an average of 8.2 years in the mental health system prior to correct diagnosis. Patients presented with many different symptoms and frequently received other psychiatric or neurological diagnoses. A history of childhood physical and/or sexual abuse was reported by 94.4% of the subjects, and 80.6% met criteria for posttraumatic stress disorder.
Patients with multiple personality disorder have a stable set of core symptoms throughout North America as well as in Europe.
http://www.ncbi.nlm.nih.gov/pubmed/8434668?dopt=Abstract

Abuse histories in 102 cases of multiple personality disorder.
The authors interviewed 102 individuals with clinical diagnoses of multiple personality disorder at four centres using the Dissociative Disorders Interview Schedule. The patients reported high rates of childhood trauma: 90.2% had been sexually abused, 82.4% physically abused, and 95.1% subjected to one or both forms of child abuse. Over 50% of subjects reported initial physical and sexual abuse before age five. The average duration of both types of abuse was ten years, and numerous different perpetrators were identified. Subjects were equally likely to be physically abused by their mothers or fathers. Sexual abusers were more often male than female, but a substantial amount of sexual abuse was perpetrated by mothers, female relatives, and other females. Multiple personality disorder appears to be a response to chronic trauma originating during a vulnerable period in childhood.
http://www.ncbi.nlm.nih.gov/pubmed/2044042?dopt=Abstract

Evidence Against Iatrogenic and Sociocognitive Models of Dissociative Identity Disorder

Evidence against the iatrogenesis of multiple personality disorder
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.
https://scholarsbank.uoregon.edu/xmlui/handle/1794/1424

Iatrogenic DID-An Evaluation of the Scientific Evidence: D. Brown, E. Frischholz & A. Scheflin” from The fall-winter 1999 issue of “The Journal of Psychiatry & Law – “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.….alter shaping is not to be confused with alter creation.” p. 624

The sociocognitive model of dissociative identity disorder: A reexamination of the evidence.
According to the sociocognitive model of dissociative identity disorder (DID; formerly, multiple personality disorder), DID is not a valid psychiatric disorder of posttraumatic origin; rather, it is a creation of psychotherapy and the media….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.
https://psycnet.apa.org/record/2001-00574-006

Dissociative identity disorder is a real condition, and it’s not quite as rare as you might imagine.  https://psychcentral.com/disorders/dissociative-identity-disorder

Separating Fact from Fiction: An Empirical Examination of Six Myths About Dissociative Identity Disorder  Bethany L. Brand, PhD, Vedat Sar, MD, Pam Stavropoulos, PhD, Christa Krüger, MB BCh, MMed (Psych), MD, Marilyn Korzekwa, MD, Alfonso Martínez-Taboas, PhD, and Warwick Middleton, MB BS, FRANZCP, MD  –  Harv Rev Psychiatry. 2016 Jul; 24(4): 257–270.  Published online 2016 Jul 8. doi: 10.1097/HRP.0000000000000100  PMCID: PMC4959824   PMID: 27384396

Abstract:  Dissociative identity disorder (DID) is a complex, posttraumatic, developmental disorder for which we now, after four decades of research, have an authoritative research base, but a number of misconceptualizations and myths about the disorder remain, compromising both patient care and research. This article examines the empirical literature pertaining to recurrently expressed beliefs regarding DID: (1) belief that DID is a fad, (2) belief that DID is primarily diagnosed in North America by DID experts who overdiagnose the disorder, (3) belief that DID is rare, (4) belief that DID is an iatrogenic, rather than trauma-based, disorder, (5) belief that DID is the same entity as borderline personality disorder, and (6) belief that DID treatment is harmful to patients. The absence of research to substantiate these beliefs, as well as the existence of a body of research that refutes them, confirms their mythical status. Clinicians who accept these myths as facts are unlikely to carefully assess for dissociation. Accurate diagnoses are critical for appropriate treatment planning.  “DID is a legitimate and distinct psychiatric disorder that is recognizable worldwide and can be reliably identified in multiple settings by appropriately trained researchers and clinicians. The research shows that DID is a trauma-based disorder that generally responds well to treatment consistent with DID treatment guidelines.”  https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4959824/

Fact or Factitious? A Psychobiological Study of Authentic and Simulated Dissocative Identity States
The findings are at odds with the idea that differences among different types of dissociative identity states in DID can be explained by high fantasy proneness, motivated role-enactment, and suggestion. They indicate that DID does not have a sociocultural (e.g., iatrogenic) origin. For the first time, it is shown using brain imaging that neither high nor low fantasy prone healthy women, who enacted two different types of dissociative identity states, were able to substantially simulate these identity states in psychobiological terms. These results do  not support the idea of a sociogenic origin for DID.”
http://www.plosone.org/article/info:doi/10.1371/journal.pone.0039279

The clinical phenomenology of multiple personality disorder: review of 100 recent cases F W Putnam, E K Silberman, L Barban, R M Post    J Clin Psychiatry . 1986 Jun;47(6):285-93.  PMID: 3711025  Abstract :  The clinical syndrome of multiple personality disorder (MPD) is an unusual dissociative condition that has been poorly characterized. In an attempt to better delineate the clinical phenomenology of MPD, 100 recent cases were collected on a 386-item questionnaire completed by clinicians involved in the treatment of MPD patients. This study documents the existence of a clinical syndrome characterized by a core of depressive and dissociative symptoms and a childhood history of significant trauma, primarily child abuse.   https://pubmed.ncbi.nlm.nih.gov/3711025/

Physiological Evidence Showing Physical Differences Between Dissociative Identity Disorder Identity States
Multiple personality disorder. A clinical investigation of 50 cases.
To study the clinical phenomenology of multiple personality, 50 consecutive patients with DSM-III multiple personality disorder were assessed using clinical history, psychiatric interview, neurological examination, electroencephalogram, MMPI, intelligence testing, and a variety of psychiatric rating scales. Results revealed that patients with multiple personality are usually women who present with depression, suicide attempts, repeated amnesic episodes, and a history of childhood trauma, particularly sexual abuse. Also common were headaches, hysterical conversion, and sexual dysfunction. Intellectual level varied from borderline to superior. The MMPI reflected underlying character pathology in addition to depression and dissociation. Significant neurological or electroencephalographical abnormalities were infrequent. These data suggest that the etiology of multiple personality is strongly related to childhood trauma rather than to an underlying electrophysiological dysfunction.
http://www.ncbi.nlm.nih.gov/pubmed/3418321

Psychobiological characteristics of dissociative identity disorder: a symptom provocation study.
Dissociative identity disorder (DID) patients function as two or more identities or dissociative identity states (DIS), categorized as ‘neutral identity states’ (NIS) and ‘traumatic identity states’ (TIS). NIS inhibit access to traumatic memories thereby enabling daily life functioning. TIS have access and responses to these memories. We tested whether these DIS show different psychobiological reactions to trauma-related memory.
RESULTS:
Psychobiological differences were found for the different DIS. Subjective and cardiovascular reactions revealed significant main and interactions effects. Regional cerebral blood flow data revealed different neural networks to be associated with different processing of the neutral and trauma-related memory script by NIS and TIS.
CONCLUSIONS:
Patients with DID encompass at least two different DIS. These identities involve different subjective reactions, cardiovascular responses and cerebral activation patterns to a trauma-related memory script.
http://www.ncbi.nlm.nih.gov/pubmed/17008145

One Brain, Two Selves
Our findings reveal the existence of different regional cerebral blood flow patterns for different senses of self. We present evidence for the medial prefrontal cortex (MPFC) and the posterior associative cortices to have an integral role in conscious experience.  http://www.ncbi.nlm.nih.gov/pubmed/14683715

Research Articles and Books about Dissociative Identity Disorder and MPD

Overcoming Multiple Personality Disorder By Anne Underwood
Multiple personality disorder is a perplexing phenomenon to outside observers, believed to be brought on by persistent childhood abuse. What is it like living with MPD? And how does a sufferer function, with so many alternate personalities—or “alters”—some of them adults and some children? NEWSWEEK’s Anne Underwood spoke with Karen Overhill—a former sufferer and the subject of a new book, “Switching Time,” by Dr. Richard Baer.
http://www.newsweek.com/overcoming-multiple-personality-disorder-103403

Multiple personality and dissociation, 1791-1992: a complete bibliography
https://books.google.com/books/about/Multiple_Personality_Dissociation_1791_1.html?id=LmqRAAAACAAJ

The official journal of the International Society for the Study of Trauma and Dissociation (ISSTD), published between 1988 and 1997
https://scholarsbank.uoregon.edu/xmlui/handle/1794/1129

Forensic Aspects of Dissociative Identity Disorder
This ground-breaking book examines the role of crime in the lives of people with Dissociative Identity Disorder, formerly known as Multiple Personality Disorder, a condition which appears to be caused by prolonged trauma in infancy and childhood. This trauma may be linked with crimes committed against them, crimes they have witnessed, and crimes they have committed under duress.
https://www.karnacbooks.com/product/forensic-aspects-of-dissociative-identity-disorder/25876/

Trauma And Dissociation in a Cross-cultural Perspective: Not Just a North American Phenomenon
An international look at the similarities and differences of long-lasting trauma – Trauma and Dissociation in a Cross-Cultural Perspective examines the psychological, sociological, political, economic, and cultural aspects of trauma and its consequences on people around the world. Dispelling the myth that trauma-related dissociative disorders are a North American phenomenon, this unique book travels through more than a dozen countries to analyze the effects of long-lasting traumatization-both natural and man-made-on adults and children.  http://www.amazon.com/Trauma-Dissociation-Cross-cultural-Perspective-Phenomenon/dp/0789034077

https://www.google.com/books/edition/Trauma_and_Dissociation_in_a_Cross_Cultu/3o_INBmLmeEC?hl=en&gbpv=1&dq=Trauma+And+Dissociation+in+a+Cross-cultural+Perspective:+Not+Just+a+North+American+Phenomenon&printsec=frontcover

Sybil in Her Own Words  Patrick Suraci Psychologist
http://www.huffingtonpost.com/patrick-suraci/post_2699_b_1152241.html

Sybil and Multiple Personality Disorder
http://sybilandmpd.blogspot.com/

Review of “Sybil in her own words”
http://sybilandmpd.blogspot.com/2011/11/review-of-sybil-in-her-own-words-by.html

Twenty-Two Faces – Inside the Extraordinary Life of Jenny Hill and Her Twenty-Two Multiple Personalities Judy Byington
http://ritualabuse.us/ritualabuse/articles/twenty-two-faces-inside-the-extraordinary-life-of-jenny-hill-and-her-twenty-two-multiple-personalities-judy-byington-msw-lcsw/

Open Letter to Dr. Phil From Jenny Hill
http://ritualabuse.us/ritualabuse/articles/open-letter-to-dr-phil-from-jenny-hill/

Basic Information on DID
Basic Information on Dissociative Identity Disorder with sections on Basic Information on DID from the DSM-IV-TR, The History of DID/MPD, Diagnosing DID, Responses to those that state that DID is iatrogenic or a social construct,  MPD/DID connection to severe abuse, Recent information and DID resources,
Physiological studies showing differences between DID patients and non-DID patients
https://ritualabuse.us/research/did/basic-information-on-didmpd/

Research and Information on Dissociative Identity Disorder (formerly called Multiple Personality Disorder) http://ritualabuse.us/research/did/

Disinformation and DID: the Politics of Memory – Brian Moss, MA, MFT
Information on the False Memory Syndrome, Mind Control, Dissociative Identity Disorder, The Media, Ritual Abuse, The Nazis and Programming.
http://ritualabuse.us/research/did/disinformation-and-did-the-politics-of-memory/

Secret Weapons – Two Sisters’ Terrifying True Story of Sex, Spies and Sabotage by Cheryl and Lynn Hersha with Dale Griffis, Ph D. and Ted Schwartz. New Horizon Press ISBN 0-88282-196-2 Is a well-documented, verifiable account of not one, but two childrens’ long untold stories of being CHILD subjects of Project MKUltra. Quotes from the book: “By the time Cheryl Hersha came to the facility, knowledge of multiple personality was so complete that doctors understood how the mind separated into distinct ego states,each unaware of the other. First, the person traumatized had to be both extremely intelligent and under the age of seven, two conditions not yet understood though remaining consistent as factors. The trauma was almost always of a sexual nature…” p. 52 “The government researchers,aware of the information in the professional journals, decided to reverse the process (of healing from hysteric dissociation). They decided to use selective trauma on healthy children to create personalities capable of committing acts desired for national security and defense.” p. 53 – 54 

Scientists Are Beginning to Understand What Causes Multiple Personality Disorder

"Researchers believe that indicates that DID sufferers do not merely have overactive imaginations, and that the origins of their ailment stem more likely from trauma."

"These results do not support the idea of a sociogenic origin for DID."

Scientists Are Beginning to Understand What Causes Multiple Personality Disorder

Despite the fact that dissociative identity disorder has been listed in psychiatry bible Diagnostic and Statistical Manual of Mental Disorders (currently DSM-IV) for years, the origins of the condition are not well-understood.  By Makini Brice  July 02, 2012

Dissociative identity disorder (DID) – or multiple personality disorder, as it is commonly known – affects one percent of the population, roughly the same amount as schizophrenia. Often sufferers from the condition have been misdiagnosed with schizophrenia and bipolar disorder before receiving their DID diagnosis. DID is usually characterized as a person who has with two or more personalities with completely different viewpoints on their environments and themselves.

Some believe that those afflicted use DID as a means of coping with extreme trauma, while others think that those affected simply have overactive imaginations. Of those who believe in the overactive imagination theory, scientists do not believe that DID is a genuine mental disorder.

Researchers at King’s College London sought to find a clearer picture of the answer to that question. They studied 29 people, 11 had dissociative identity disorder, 10 were people who were highly prone to fantasy and 8 people were not very prone to fantasy, as a control. Of those without DID, they were made to simulate the symptoms of dissociative identity disorder. The researchers measured subjects’ brain activity, cardiovascular system, and their reactions.

They found that there were strong differences, both in regional blood flow and in reactions, between the DID sufferers and the control subjects. Researchers believe that indicates that DID sufferers do not merely have overactive imaginations, and that the origins of their ailment stem more likely from trauma.... http://www.medicaldaily.com/news/20120702/10574/dissociative-identity-disorder-multiple-personality-brain-mental-trauma.htm


Fact or Factitious? A Psychobiological Study of Authentic and Simulated Dissociative Identity States
A. A. T. Simone Reinders, Antoon T. M. Willemsen, Herry P. J. Vos, Johan A. den Boer, Ellert R. S. Nijenhuis PLoS ONE 7(6): e39279. doi:10.1371/journal.pone.0039279

Abstract

Background

Dissociative identity disorder (DID) is a disputed psychiatric disorder. Research findings and clinical observations suggest that DID involves an authentic mental disorder related to factors such as traumatization and disrupted attachment. A competing view indicates that DID is due to fantasy proneness, suggestibility, suggestion, and role-playing. Here we examine whether dissociative identity state-dependent psychobiological features in DID can be induced in high or low fantasy prone individuals by instructed and motivated role-playing, and suggestion.

Methodology/Principal Findings

DID patients, high fantasy prone and low fantasy prone controls were studied in two different types of identity states (neutral and trauma-related) in an autobiographical memory script-driven (neutral or trauma-related) imagery paradigm. The controls were instructed to enact the two DID identity states. Twenty-nine subjects participated in the study: 11 patients with DID, 10 high fantasy prone DID simulating controls, and 8 low fantasy prone DID simulating controls. Autonomic and subjective reactions were obtained. Differences in psychophysiological and neural activation patterns were found between the DID patients and both high and low fantasy prone controls. That is, the identity states in DID were not convincingly enacted by DID simulating controls. Thus, important differences regarding regional cerebral bloodflow and psychophysiological responses for different types of identity states in patients with DID were upheld after controlling for DID simulation.

Conclusions/Significance

The findings are at odds with the idea that differences among different types of dissociative identity states in DID can be explained by high fantasy proneness, motivated role-enactment, and suggestion. They indicate that DID does not have a sociocultural (e.g., iatrogenic) origin.

"For the first time, it is shown using brain imaging that neither high nor low fantasy prone healthy women, who enacted two different types of dissociative identity states, were able to substantially simulate these identity states in psychobiological terms. These results do not support the idea of a sociogenic origin for DID." http://www.plosone.org/article/info%3Adoi%2F10.1371%2Fjournal.pone.0039279

Paul McHugh

Information on Paul McHugh

Bishops Select Lay Board On Sexual Abuse Review By Laurie Goodstein 6/25/02 “Dr. McHugh, who was a founder and board member of the False Memory Syndrome Foundation.” http://query.nytimes.com/gst/fullpage.html?res=9C0DEFD91038F936A15754C0A9649C8B63

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. 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.” (Gleaves, D. July 1996 The sociocognitive model of dissociative identity disorder: a reexamination of the evidence, Psychological Bulletin 120, 1 p.42-59 http://www.ncbi.nlm.nih.gov/pubmed/8711016?ordinalpos=1&itool=EntrezSystem2.PEntrez.Pubmed.Pubmed_ResultsPanel.Pubmed_RVAbstractPlus) “ No reason exists to doubt the connection between DID and childhood trauma.” http://ritualabuse.us/research/did/basic-information-on-didmpd/ 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.

Morrison threatens to sue witness - Expert witness Paul McHugh, a psychiatrist, could face disciplinary action for revealing information in Wichita abortion records. By Dion Leflert 6/13/07 Wichita Eagle - Kansas Attorney General Paul Morrison on Tuesday threatened to sue a psychiatric expert hired by his predecessor if he doesn’t stop making public statements about medical records from an investigation of Wichita abortion provider George Tiller. In a letter, Morrison told psychiatrist Paul McHugh that if he persists, the attorney general’s office will “pursue all available remedies.” That could include legal action to get a refund of $5,000 the state has paid McHugh and possible disciplinary action against him in his home state of Maryland. http://www.accessmylibrary.com/coms2/summary_0286-31256521_ITM

Dubious choice for resolving church scandal by Mara J. Math 9/21/02 “McHugh’s actions…pose the deepest threat to the council’s credibility. McHugh is the only therapist on the lay council. This makes his participation especially significant, because other members may rely on his presumed expertise. Because he frequently testifies on behalf of accused molesters, doubts may be raised about the council’s desire to truly solve the problem. McHugh…is the man whose report to the court in one case stated that a defendant’s harassing phone calls were not obscene - including the call that detailed a fantasy of a 4-year-old sex slave locked in a dog cage and fed human waste. At least eight men have been convicted of sexually abusing Maryland children while under treatment at the “sex disorders” clinic McHugh runs at Johns Hopkins University School of Medicine - abuse the doctors did not report, citing client confidentiality. When Maryland law was changed to require that doctors report child molestation, the clinic fought it and advised patients on how to get around the law. The memo to patients suggested that molesters report their pedophilic activities to their lawyers, who could in turn tell staff; attorney-client privilege would then protect the molesters from being reported. This memo was fully approved by the boss - Dr. Paul McHugh…” http://www.sfgate.com/cgi-bin/article.cgi?file=/chronicle/archive/2002/09/20/ED175849.DTL

Paul McHugh on transsexualism - From an article by Elizabeth Gilbert: McHugh has always reserved special scorn for the practice of sex-change surgery on adult transsexuals. Classifying transsexualism as merely one symptom in a larger complex of personality disorders, McHugh had long believed that psychiatrists should treat such patients with the talking cure, not radical, irreversible surgeries. In a 1992 article in the American Scholar, McHugh lambasted transsexual surgery as ‘the most radical therapy ever encouraged by twentieth century psychiatrists’ and likened its popularity to the once widespread practice of frontal lobotomy. http://www.tsroadmap.com/info/paul-mchugh.html

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 https://scholarsbank.uoregon.edu/dspace/bitstream/1794/1424/1/Diss_2_2_2_OCR.pdf

“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. https://scholarsbank.uoregon.edu/dspace/bitstream/1794/1428/1/Diss_2_2_6_OCR.pdf
“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 https://scholarsbank.uoregon.edu/dspace/bitstream/1794/1425/1/Diss_2_2_3_OCR.pdf
“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. http://www.psyter.org/allegati/180/Kluft.pdf
“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. https://scholarsbank.uoregon.edu/dspace/bitstream/1794/1837/1/Diss_10_1_9_OCR.pdf
"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 http://www.isst-d.org/

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. http://boundless.uoregon.edu/cgi-bin/showfile.exe?CISOROOT=/diss&CISOPTR=38&filename=39.pdf

blog on book “Switching Time” by Richard Baer http://switchingtime.wordpress.com/