History of Dissociative Identity Disorder

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Dissociative identity disorderPrior to the DSM-IV, <ref name=DSMIV/> <ref name=DSM5Deskref/> dissociative identity disorder was known as multiple personality disorder in the DSM manual from 1980-1994. The International Classification of Diseases,(ICD) still uses this label, <ref name=ICD10/> even though the ICD-11 is expected to change it. The term is misleading and well known that no one can have more than one personality, nor is the disorder a personality disorder. {{See also| Multiple Personality Disorder}}Dissociative identity disorder is a disorder of mental states, where a individual has amnesia due to switching between different personality states (also known as alters). <ref name=Dell2009/>{{Rp|319-321}} {{See also| Dissociative Identity Disorder}} has historically been known by many different terms, including multiplex personalityEvery individual has a personality that is composed of many diverse, fragmentary and generally illusory images of [[Personality|self]]. (see multiples) <ref name=Noricks2011/>The DSM-IV uses the term identity in its definition of dissociation. (see identity) <ref name=Dell2009/>{{Rp|127}}, double existences, dual personality, double personality (1790s), plural personality, dissociated personality (DSMPublished by the American Psychiatric Association as the standard classification of mental disorders used by US mental health professionals. It consists of diagnostic classification, the diagnostic criteria sets, and descriptive text. The DSM-II listed multiple personality disorder as a symptom of hysterical neurosis, dissociative type. The DSM-III (1980) moved Multiple Personality Disorder from a symptom to its own disorder. The DSM-IV changed the name to dissociative identity disorder (1994) and the DSM-5 (May 2013) updated the listing to current standards. <ref name=DSMIV/> <ref name=DSM5/> <ref name=Dell2009/>{{Rp|384}}-I, 1952), multiple personality (case of Louis Vivet, 1880s), split1. In dissociative identity disorder - the part of the personality that will take abuse already exist in a child inner world (see inner world). What occurs is an ongoing separation of parts, rather than a "split or fracture" of one part from another. <ref name=Howell2011/>{{Rp|87-88}} The term "splitting or fractured" used when describing dissociative identity disorder is a misnomer. For example: a child on the ceiling watching a disturbing event, has not "split off" from the part of the personality that is enduring that trauma event, however the individual might develop Acute Stress Disorder (ASD) or posttraumatic stress disorder (PTSD). In dissociative identity disorder a long history of chronic abuse is almost always present, as well as the child typically having a disorganized attachment with their caregiver(s). <ref name=Dell2009/>{{Rp|302-306}} <br />2. Not in DID - Viewing oneself or others as being all good or all bad, common in borderline personality disorder. A psychological defense mechanism.<ref name=Seligman2004/>{{Rp|121}} {{See also| Borderline personality disorder}} personality, multiple personality disorderPrior to the DSM-IV, <ref name=DSMIV/> <ref name=DSM5Deskref/> dissociative identity disorder was known as multiple personality disorder in the DSM manual from 1980-1994. The International Classification of Diseases,(ICD) still uses this label, <ref name=ICD10/> even though the ICD-11 is expected to change it. The term is misleading and well known that no one can have more than one personality, nor is the disorder a personality disorder. {{See also| Multiple Personality Disorder}} (MPDPrior to the DSM-IV, <ref name=DSMIV/> <ref name=DSM5Deskref/> dissociative identity disorder was known as multiple personality disorder in the DSM manual from 1980-1994. The International Classification of Diseases,(ICD) still uses this label, <ref name=ICD10/> even though the ICD-11 is expected to change it. The term is misleading and well known that no one can have more than one personality, nor is the disorder a personality disorder. {{See also| Multiple Personality Disorder}}) (DSM-IV, 1980)[6]:1 and exchanged personality (1790s) [7]:83. Many of these terms were originally introduced by French or German speaking physicians, which may have led to different terms partly as a result of translating meanings between languages. Throughout historical literature the symptoms of dissociative identity disorderPrior to the DSM-IV, <ref name=DSMIV/> <ref name=DSM5Deskref/> dissociative identity disorder was known as multiple personality disorder in the DSM manual from 1980-1994. The International Classification of Diseases,(ICD) still uses this label, <ref name=ICD10/> even though the ICD-11 is expected to change it. The term is misleading and well known that no one can have more than one personality, nor is the disorder a personality disorder. {{See also| Multiple Personality Disorder}}Dissociative identity disorder is a disorder of mental states, where a individual has amnesia due to switching between different personality states (also known as alters). <ref name=Dell2009/>{{Rp|319-321}} {{See also| Dissociative Identity Disorder}} have been described alongside other dissociative symptoms or disorders, including amnesia (a symptom still required for diagnosis today), fugue, derealization and depersonalization, physical symptoms such as non-epileptic pseudoseizures and a known history of child abuse.

Adam Crabtree researched the history of Dissociative Identity Disorder in 1993, when it was known as Multiple Personality Disorder , stating:

Recognition of dissociation as a means of dealing with traumatic material by forming multiple psychic centers led to all effective psychotherapy for Multiple Personality Disorder. The etiological role of child abuse"interactions in which one person behaves in a violent, demeaning or invasive manner towards another person (e.g. child or partner)" <ref name=VandenBos2007/> was not acknowledged until modern times, but statistical evidence of sexual crimes against children in later nineteenth-century France may provide a fruitful area of research. A scrutiny of historical cases raises questions about the equivocalness of the concept of multiple personality. It also reveals data that have not yet been fully acknowledged by modern clinicians."[1]

1584-1585 Jeanne Fery - the first documented case of DIDDissociative identity disorder is a disorder of mental states, where a individual has amnesia due to switching between different personality states (also known as alters). <ref name=Dell2009/>{{Rp|319-321}} {{See also| Dissociative Identity Disorder}}

Crabtree (1993) identified two key periods of understanding:

The history of the diagnosis and treatment of multiple personality during the 160-year period preceding The Three Faces of Eve [8] falls into two periods: the magnetic sleep period and the dissociation period. Using magnetic sleep techniques, early investigators learned to control switchingFull dissociation is when an alter switches with the alter currently in executive control, resulting in amnesia for that alter. (see executive control) <ref name=Howell2011/>{{Rp|4-6}} In full dissociation, there is complete amnesia between alters, which is a <ref name=Dell2009/>{{Rp|228}} criteria for a diagnosis of Dissociative Identity Disorder in the DSM. {{See also| Dissociation}} and trust the patient for guidance in the treatment."[1]
Désiré-Magloire Bourneville

Despite Crabtree's assertion that the history of dissociative identity disorder goes back to around 1790, a number of researchers have found evidence of cases of DID existing over 200 years before this date. Bliss (1980) credits Paracelsus as the first documented reference to multiple personalities, but Bliss' 1646 reference has not been confirmed.[9] Shortly after Crabtree's research was published a number of cases were discovered from before this time, dating back to at least the 16th century; at the time these were regarded as "individuals possessed by devils and demons",[3]:4 for example the case of Jeanne Fery (Bourneville, 1886)[3]:4, a 25 year old nun from Mons, France. [3]:1

Jeanne Fery is believed to be the earliest historical case of DID which can be confidently diagnosed. Fery wrote an account of her own "exorcism" from 1584-5, which was also recorded in great detail by her exorcists, and was republished by Bourneville in 1886; an account of this 109 page description was first published in English in 1996. Bourneville, a colleague of Pierre Janet, diagnosed this as a case of "doubling of the personality", and his description includes all the major criteria and associated features found in the DSM psychiatric manual for the diagnosis of Dissociative identity disorder.[3]:1
La Possession De Jeanne Féry, Religieuse Professe Du Couvent Des Soeurs Noires De La Ville De Mons (1584)
Fery's exorcists described the "fragmentation of her identity" and a history of childhood trauma.[3]:1 Fery's alter identities included several internal "devils" who function as protectors, a "demon" who controls her disturbed eating and another called Sanguinaire ("Bloodthirsty") who self-injures by cutting. A third "devil", called Garga ("Throat"), protects her from feeling the pain of childhood beatings but also reenacts the trauma using different forms of self-harm and suicide attempts.[3]:1 Her highly rational and helpful alter identityAltered states of consciousnessExchangeable terms include parts, dissociative parts, personality states, self-states, states, identities, selves, or ego states. Alters are present only in those with dissociative identity disorder or similar presentations of other specified dissociative disorder, where the parts of the personality are highly dissociated and isolated. No alter, including the host alter, is a complete personality, even though an alter might feel as if they are. <ref name=Howell2011/>{{Rp|55-67}}Alters are psychodynamically interacting parts, each with their own separate centers of subjectivity, identity, autonomy, and sense of personal history. <ref name=Howell2011/>{{Rp|55}}An individual with dissociative identity disorder may have few or many |alters, which include a variety of ages, cross gender, animal or objects, with coconsciousness (see coconsciousness) at varying degrees, and [[communication]] can be limited to one direction. (one way amnesia) <ref name=Dell2009/>{{Rp|301}} appears at moments of crisis and "might be described in twentieth-century terms as an internal self helper".[3]:1 She also experiences well known dissociative symptoms which match descriptions of dissociationThis explanation refers to pathological dissociation only; which is dissociation which is a symptom of or causes a mental health disorder. For normative dissociation see Dissociation page. Dissociation is a compartmentalization of experience, where elements of a trauma are not integrated into a unified sense of the Self. <ref name=Dell2009/>{{Rp|4-810, 127}}The lay persons idea of [[dissociation]], that which exists in the normal mind, is not what is referred to in this document. True or pathological dissociation requires an experiencing Self. <ref name=Dell2009/>{{Rp|233-234}} [conversion"The development of symbolic physical symptoms and distortions involving the voluntary muscles or special sense organs; not under voluntary control and not explained by any physical disorder." (Kaplan & Sadock, 2008). Functional Neurological Symptom Disorder is the new name for Conversion Disorder in the DSM-5 manual, and is part of the Somatic Symptom and Other Related Disorders category. Somatization Disorder was removed during the changes, but is represented in this category. <ref name=DSM5changes/>{{Rp|11}}Conversion symptoms are most common in conversion disorder, but also seen in a variety of mental disorders." <ref name=Sadock2008/>{{Rp|23}}"Conversion disorders" is the ICD-10 category includes somatoform dissociation within dissociative disorders of movement and sensation.<ref name=Nijenhuis2001/> {{Rp|9}}{{See also| Somatoform Disorders}}] disorders in the ICD-10 manual and expert descriptions of DID, including amnesia for the actions of altersAltered states of consciousnessExchangeable terms include parts, dissociative parts, personality states, self-states, states, identities, selves, or ego states. Alters are present only in those with dissociative identity disorder or similar presentations of other specified dissociative disorder, where the parts of the personality are highly dissociated and isolated. No alter, including the host alter, is a complete personality, even though an alter might feel as if they are. <ref name=Howell2011/>{{Rp|55-67}}Alters are psychodynamically interacting parts, each with their own separate centers of subjectivity, identity, autonomy, and sense of personal history. <ref name=Howell2011/>{{Rp|55}}An individual with dissociative identity disorder may have few or many |alters, which include a variety of ages, cross gender, animal or objects, with coconsciousness (see coconsciousness) at varying degrees, and [[communication]] can be limited to one direction. (one way amnesia) <ref name=Dell2009/>{{Rp|301}}, mutism and conversion blindness (dissociative stupor), inexplicably lost and found objects (dissociative amnesia), experiences of possession (trance and possession disorders), (dissociative convulsions), hearing voices arguingTwo or more voices conversing, they may be arguing. Common in both schizophrenia and dissociative identity disorder. This is a type of auditory hallucination. <ref name=Sadock2008/>{{Rp|45}} In dissociative identity disorder the voices belong to alter identities and this may extend to alters who are contending for physical control, for example involving the person feeling a force or an "other" that ties to control or change the person's actions, or feeling or hearing an angry other that tries to control the person.<ref name=Dell2009/>{{Rp|230}}[10]:230 and alters holding onto intense rage and overwhelming sadlness.[10]:234 Also present are physical symptoms which are typically present in dissociative identity disorder and known as somatoform symptoms,[10]:230 in Fery's case these included intense physical pain, pseudoseizures and headaches.[3]:1 Many symptoms were relapsed or exacerbated during the "exorcism rituals"[3]:1, but the account of Fery's recovery describes being treated with "constant care" from her fellow nuns, and "her exorcists' consent to her request that they replace her demons as father and grandfather"; Hart (1996) states that "some of these 'accidental' elements of the exorcism parallel current understanding of trauma-dissociative disorders and recovery process (van der Hart & van der Velden, 1987; Goodwin, Hill & Attias, 1990)".[3]:2

1585 to 1794

Another detailed account from the sixteen century describes the experiences of Sister Benedetta, abbess of a Theatine convent in Italy, in 1623 (Brown, 1986).[3]:1 She was described as being possessed by three "angelic boy" alters who would at times beat her causing chronic pain, and take over control of her body, each "speaking a different dialect and producing specific facial expressions and tones of voice." She had amnesiaMemory loss. {{See also| amnesia}} for some acts done by these alters. In Benedetta's case there were hints at the presence of childhood traumaThe most fundamental effect of trauma is dissociation, so we define trauma as the event(s) that cause dissociation. <ref name=Howell2011/>{{Rp|75}} The original trauma in those with dissociative identity disorder was failure of secure attachment with a primary attachment figure in early childhood. <ref name=Howell2011/>{{Rp|83}}.[3]:1

From 1791 to 1880 the only coherent theory of multiple personality was based on magnetic somnambulismHistorically somnambulism was described as a dissociative symptom. Taylor (2000){{Rp|106}} states that the term "dissociation" was first coined in psychology by William James, who used the term to explain alterations of consciousness, including somnambulism, dissociative fugue and "conditions of double consciousness". Personality was considered a "plurality of states" of which waking consciousness was only one such state, <ref name=Taylor2000/> meaning performing actions apparently without conscious awareness of those actions. or magnetic sleep, referred to by Crabtree as the "magnetic sleep period".[1] In 1791 Eberhardt Gmelin wrote a detailed 87 page account about a case of "double personality",[11]:4 which he referred to as "exchanged personality" (umgetaushte Persönlichkeit),[12]: 355 describing a twenty-one year-old Stuttugart woman who suddenly exhibited a personality who spoke French rather than German and adopted French mannerisms; both her French and German speaking identities were unaware of each other. [13] [1] [12]:355

1794 to 1880

A detailed description of a different state of consciousness was described by the Marquis de Puysegur in France, in the spring 1784. He used a technique he later called "magnetic sleep" or artificial somnambulism on an ailing employee, Victor Race, noticing obvious personality changes, a separation in consciousness and amnesia which was not present in those he had previously used the technique on. [1] Rather than showing the transient symptoms of hypnosis, Victor Race appeared to have the "stable dissociative parts" of a personality, consistent with the trauma-induced "multiple personality" cases. [11]:20

In 1812 Benjamin Rush, considered "the father of American psychiatry"[14]:1967 wrote a chapter about what he called "DissociationThis explanation refers to pathological dissociation only; which is dissociation which is a symptom of or causes a mental health disorder. For normative dissociation see Dissociation page. Dissociation is a compartmentalization of experience, where elements of a trauma are not integrated into a unified sense of the Self. <ref name=Dell2009/>{{Rp|4-810, 127}}The lay persons idea of [[dissociation]], that which exists in the normal mind, is not what is referred to in this document. True or pathological dissociation requires an experiencing Self. <ref name=Dell2009/>{{Rp|233-234}}" in his psychiatric text; the first used of term dissociation in a medical context. [11]:5 In 1816 S. L. Mitchell presented the case of Mary Reynolds in the United States. [11]:4 Johann Christian Reil (1759-1813), a professor of medicine in Halle, and head of the clinical institute, is remembered for introducing psychological approaches to German psychiatry. [15] He described multiple personalities as a psychological disorder. [16] [15]

1880 to 1910

The next major phase, from 1880 to the early 1950s, began with a recognition of dissociation and the fact that an individual may be divided into any number of psychic centers arising as the psycheThe Greek word for soul. It is also used in psychology to signify the mind and/or personality. Psyche was also Carl Jung's term for total personality. <ref name=Basavanna2000/>{{Rp|338}} attempts to deal with traumatic experiences. This has been referred to as the "dissociation period". Crabtree (1993)

While Frenchman Louis Auguste Vivet was not the first patient to be described as having multiple personalities he was the first to be explicitly named with multiple personality (rather than double). He was probably the most extensively studied case of "male hysteriaThe prejudicial term "hysterical" came from the myth that hysteria is a specific disorder of women.<ref name=Decker2013/>{{Rp|218}}Hysteria is an historic term which refers to several different disorders. The DSM-II (1968) listed "multiple personality" as a symptom of "Hysterical Neurosis, dissociative type". This later become Multiple Personality Disorder before being renamed to Dissociative Identity Disorder, retaining code 300.14, and becoming part of the Dissociative Disorders category along with Depersonzaliation Disorder (formerly Depersonzaliation Neuroses)."Hysterical Neurosis, conversion type" was listed under "Neuroses" in the DSM-II (code 300.13), and later became "Somatoform Disorder", but is now known as Somatization Disorder in the DSM manual, and Conversion Disorders in the ICD manual.<ref name=Decker2013/>{{Rp|612}} This represents physical symptoms which are common in dissociative disorders.Hysteria also refers to physical symptoms which are believed to have an unconscious psychological cause, for example Conversion Disorder. "Hysteria is still stigmatized and frequently associated with lying or malingering." However, symptoms are not under the person's voluntary control. (Cottencin, 2013)Hysterical Personality Disorder was renamed to Histronic Personality Disorder. The prejudicial term "hysterical" came from the myth that hysteria is a specific disorder of women.<ref name=Decker2013/>{{Rp|218}}"[17]:1 as it was then known, due to having been admitted to several different asylums from 1880-1886. Vivet's traumatic childhood included an unknown father and a mother who beat him, kept him underfed and was addicted to "shamelessness". From very early childhood he suffered from hysteria, hemoptysis (coughing up blood) and "temporal paralysis" (see dissociative motor disorders) which over time caused muscle wastage in his lower limbs. At age 8 he became homeless and a thief.[17]:2 In 1992 an extreme claim was made that his DID was "iatrogenic"[17]:2 (caused by medical malpractice) but this ignored a number of historical accounts of Vivet's condition. In 1995 Hacking's book Rewriting the soul: Multiple personality and the science of memory"Memory is not a static thing, but an active set of processes." <ref name=Siegel/>{{Rp|51}} "Our earliest experiences shape not only what we remember, but also how we remember and how we shape the narrative of our lives. Memory can be seen as the way the mind encodes elements of experience into various forms of representation. As a child develops, the mind begins to create a sense of continuity across time, linking past experiences with present perceptions and anticipations of the future." <ref name=Siegel/>{{Rp|11}} attempted to present Vivet as a case of double rather than multiple personality (claiming additional identities were created by malpractice), but this minority view was proved to be incorrect when French psychiatristProfessionals who are medically trained doctors with specialist training in psychiatry. They can prescribe medication, diagnose and conduct research. Besides psychiatric medication treatments include ECT and psychotherapy. <ref name=AboutPsychiatry/> Dr Henri Faure discovered Vivet's original medical file soon after the book's publication.[17]:1
Pierre Janet

Between 1880 and 1920, many great international medical conferences devoted a lot of time to sessions on dissociation. During this period Jean-Martin Charcot introduced his ideas of the impact of "nervous" shocks as a cause for a variety of neurological conditions. One of Charcot's students, Pierre Janet,[16] took these ideas and went on to develop his own theories of dissociation, which was then known as "hysteria".[16] Janet, best known for the introduction of medical psychotherapy in France, published a major article on the "doubling of personality" in 1886,[15] which was entitled "Les actes inconscients et le dédoublement de la personnalité pendant líétat somnambulisme provoqué",[18] which can be roughly translated as "unconscious acts and the doubling of the personality during a state caused by somnambulism". By the late 19th century it was accepted that emotionally traumatic experiences could cause long-term disorders with a variety of symptoms, with Janet concluding that extreme dissociation resulted in Multiple Personality[16] (now known as DID).

One of the first individuals diagnosed with "multiple personalities" to be scientifically studied was Clara Norton Fowler, under the pseudonym Christine Beauchamp;[19] American neurologist Morton Prince studied Fowler between 1898 and 1904, describing her case study in his 1906 monograph, Dissociation of a PersonalityEvery individual has a personality that is composed of many diverse, fragmentary and generally illusory images of [[Personality|self]]. (see multiples) <ref name=Noricks2011/>The DSM-IV uses the term identity in its definition of dissociation. (see identity) <ref name=Dell2009/>{{Rp|127}}. [20] Prince also described the notion of coconsciousness at this time.[20][19]

The "dissociation period" continued, but interest in dissociation and "multiple personalities" was reduced for a number of reasons. After Charcot's death in 1893, Janet continued his work on dissociation and published "The major symptoms of hysteria" in 1907. Sigmund Freud also researched dissociative disorders and the link to abuse although Freud recanted his earlier emphasis on dissociation and childhood trauma due to peer pressure.

1910 to 1930

In 1918, the Statistical Manual for the use of Institutions for the Insane was released in the United States;this was the forerunner for the Diagnostic and Statistical Manual of Mental Disorders, and was provided free of charge to any cooperating institution.[21] A description of most key aspects of Dissociative Identity DisorderPrior to the DSM-IV, <ref name=DSMIV/> <ref name=DSM5Deskref/> dissociative identity disorder was known as multiple personality disorder in the DSM manual from 1980-1994. The International Classification of Diseases,(ICD) still uses this label, <ref name=ICD10/> even though the ICD-11 is expected to change it. The term is misleading and well known that no one can have more than one personality, nor is the disorder a personality disorder. {{See also| Multiple Personality Disorder}} was included in the "Psychoneuroses and Neuroses" group, which covered conditions "in which mental forces or ideas of which the subject is either aware (conscious) or unaware (unconscious) bring about various mental and physical symptoms; in other words these disorders are essentially psychogenic in nature." The description of Hysterical Psychoneuroses reflects amnesia, dissociated emotions, dissociation ("dream states", dissociative (conversion) disorders and alterations in levels of consciousness. The entry reads:

The following types are sufficiently well defined clinically to be specified : (a) Hysterical type: Episodic mental attacks in the form of delirium"Acute reversible mental disorder characterized by confusion and some impairment of consciousness; generally associated with emotional liability, hallucinations or illusions, and inappropriate, impulsive, irrational, or violent behavior delusion"<ref name=Sadock2008/>{{Rp|24}}, stupor or dream states during which repressed wishes, mental conflicts or emotional experiences detached from ordinary consciousness break through and temporarily dominate the mind. The attack is followed by partial or complete amnesia. Various physical disturbances (sensory and motor) occur in hysteria, and these represent a conversion of the affect"a person's present emotional responsiveness, which can be inferred from facial expressions" including both the degree and range of expressive behavior. This can also be shown in tone of voice, hand and body movements. <ref name=Sadock2008/>{{Rp| 6}} of the repressed disturbing complexes into bodily symptoms or, according to another formulation, there is a dissociation of consciousness relating to some physical function."[21]:26
In 1910, Eugen Bleuler introduced the term Schizophrenia to replace "dementia praecox", the term schizophrenia was derived from the Greek, meaning 'split mind disorder'.[4]:238Ross (2006):239 states that this historic description of schizophrenia did not resembles the DSM-IV criteria for schizophrenia; but closely resembled the criteria for dissociative identity disorder; commenting on the overlap and lack of distinction between dissociative identity disorder and schizophrenia in professional literature which existed for more than a century. Ross (2006):242 also provides evidence that the positive symptoms"In schizophrenia - hallucinations, delusions, and thought disorder" <ref name=Sadock2008/>{{Rp|29}} of schizophrenia are more common in dissociative identity disorder; which may explain why schizophrenia is still a very common misdiagnosis. Starting in about 1927, there was a large increase in the number of reported cases of Schizophrenia, which was matched by an equally large decrease in the number of "multiple personality" reports. Bleuler also included "multiple personality" in his category of Schizophrenia. Bleuer's description of schizophrenia was one of the reasons 1903 through 1978 showed a dramatic decline in the number of reports of "multiple personality" after the diagnosis of Schizophrenia became popular, especially in the United States.[22][4]:238

1930 to 1950

1957-3-faces-of-eve.png

In 1950, Eugen Bleuler, still regarded as a pioneer for his work on schizophrenia, described it as a lack of integration and unity in the personality:

The disease is characterized by a specific type of alteration of thinking, feeling, and relation to the external world which appears nowhere else in this particular fashion. In every case we are confronted with a more or less clear-cut splitting1. In dissociative identity disorder - the part of the personality that will take abuse already exist in a child inner world (see inner world). What occurs is an ongoing separation of parts, rather than a "split or fracture" of one part from another. <ref name=Howell2011/>{{Rp|87-88}} The term "splitting or fractured" used when describing dissociative identity disorder is a misnomer. For example: a child on the ceiling watching a disturbing event, has not "split off" from the part of the personality that is enduring that trauma event, however the individual might develop Acute Stress Disorder (ASD) or posttraumatic stress disorder (PTSD). In dissociative identity disorder a long history of chronic abuse is almost always present, as well as the child typically having a disorganized attachment with their caregiver(s). <ref name=Dell2009/>{{Rp|302-306}} <br />2. Not in DID - Viewing oneself or others as being all good or all bad, common in borderline personality disorder. A psychological defense mechanism.<ref name=Seligman2004/>{{Rp|121}} {{See also| Borderline personality disorder}} of the psychic functions. If the disease is marked, the personality loses its unity; at different times different psychic complexes seem to represent the personality. IntegrationIntegration (state of unification) occurs in the minds of all individuals and is a process rather than an end product. "If integration is impaired, the result is chaos, rigidity, or both. Chaos and rigidity can then be seen as the red flags of blocked integration and impaired development of the mind." <ref name=Siegel2012/>{{Rp|9}} The natural process of the mind is to link differential parts (distinct modes of information processing) into a functional and unified self. No child has unified personality when born, in fact, they need years of sufficient nurturing for the parts of their personality to integrate. (see multiple) <ref name=Siegel2012/>{{Rp|394}} "Integration is more like making a fruit salad than like making a smoothie: It requires that elements retain their individual uniqueness while simultaneously linking to other components of the system. The key is balance of differentiation and linkage." <ref name=Siegel2012/>{{Rp|199}} Integration is the normal process that occurs in early childhood, but if interrupted by trauma and disorganized attachment, the child may not be able to integrate, resulting in a dissociative disorder. <ref name=Howell2011/>{{Rp|143}} As an adult, when therapy is sought out, an individual who has unresolved trauma and lacks integration, can finally get the help needed to process the trauma memories, which needs to be done prior, and to finally [integrate the alters making up the ersonality into one unified self. <ref name=Noricks2011/>{{Rp|141-144}} of different complexes and strivings appears insufficient or even lacking. The psychic complexes do not combine in a conglomeration of strivings with a unified resultant as they do in a healthy person; rather, one set of complexes dominates the personality for a time, while other groups of ideas or drives are "split off" and seem either partly or completely impotent."[23]:9

Ferenczi, an army psychiatrist during World War I, was also a psychoanalytic writer who investigated divided personality states. He referred to "splits in the personality" as reflecting the structure of the psyche, stating that the spits in personality were related to childhood trauma.[24] This provided a basis prototype of the posttraumatic model of dissociation and Dissociative Identity Disorder. Fairburn (1944/1992) viewed dissociation as the basis of hysteria, referring to involving it as a split of the ego. [24] Dissociation was also studied by Lipton (1943), Taylor & Martin (1944) and Maddison (1945). It was recognized in the 1980s that Dissociative Identity Disorder patients are often misdiagnosed as suffering from Schizophrenia and this is still the case now.[25]

Three-faces-of-eve.png
The Diagnostic and Statistical Manual of Mental Disorders DSM was first published in 1952 by the American Psychiatric Association (APAThe APA is a scientific and professional organization that represents psychiatrists in the United States. The American Psychiatric Association publishes the DSM. <ref name=DSMIV/> <ref name=DSM5/> Commonly confused with the American Psychological Association.)[26][27] but did not become frequently used until the 1968 publication of the DSM-II.[28] The DSM-I separated dissociative reactions from other reactions,[14]:1965 clearing recognizing dissociation. The DSM-I entry reads

"000-x02 Dissociative reaction
This reaction represents a type of gross personality disorganization, the basis of which is neuroticNeurosis is an emotional disorder. Neurotic refers to a person displaying a symptom of emotional distress, which could range from anxiety, panic attacks depression, and lying, to promiscuity. <ref name=Hook2004/>{{Rp|97}} This historical term referred to a very large group of conditions, which were later divided between Mood Disorders, Dissociative Disorders, Anxiety Disorders, Somatization Disorder and Personality Disorder. Neurosis was removed from the DSM completely because it suggested a "cause" common to the categories under that term, and to "reduce confusion" <ref name=Decker2013/>{{Rp|272}} disturbance,although diffuse dissociation may at times appear psychoticA person experiencing psychosis, or a characteristic of psychosis. <ref name=Sadock2008/>{{Rp|24}}... The repressed impulse giving rise to the anxiety may be discharged by, or deflected into, various symptomatic expressions, such as depersonalization, dissociated personality, stupor, fugue, amnesia, dream state, somnambulism, etc"[29]:22

The term "dissociated personality" is similar to the DSM-IV's term "dissociated statesThe highly dissociated and compartmentalized personality states found in Dissociative Identity Disorder are called alters, but dissociated personality states occur in other instances such as Dissociative Disorder Not Otherwise Specified. Other terms meaning the same thing include: dissociated part, dissociated part of Self and disaggregate Self-state, but often the same terms used for non-dissociated state are used for dissociated states. {{See also| Alters}} {{See also| Personality}}", is one of several different terms used to describe dissociative identity disorder.[30][6]:1 However, before the DSM-II the DSM-I was often not used; instead many professionals continued to use the 1942 "Standard Nomenclature of Disease", a revision of the American Medical Association's 1934 classification; this was known commonly referred to as the 1942 Revised Classification (RC). Dissociative identity disorder's classification in the RC was under the diagnosis of "HysteriaThe prejudicial term "hysterical" came from the myth that hysteria is a specific disorder of women.<ref name=Decker2013/>{{Rp|218}}Hysteria is an historic term which refers to several different disorders. The DSM-II (1968) listed "multiple personality" as a symptom of "Hysterical Neurosis, dissociative type". This later become Multiple Personality Disorder before being renamed to Dissociative Identity Disorder, retaining code 300.14, and becoming part of the Dissociative Disorders category along with Depersonzaliation Disorder (formerly Depersonzaliation Neuroses)."Hysterical Neurosis, conversion type" was listed under "Neuroses" in the DSM-II (code 300.13), and later became "Somatoform Disorder", but is now known as Somatization Disorder in the DSM manual, and Conversion Disorders in the ICD manual.<ref name=Decker2013/>{{Rp|612}} This represents physical symptoms which are common in dissociative disorders.Hysteria also refers to physical symptoms which are believed to have an unconscious psychological cause, for example Conversion Disorder. "Hysteria is still stigmatized and frequently associated with lying or malingering." However, symptoms are not under the person's voluntary control. (Cottencin, 2013)Hysterical Personality Disorder was renamed to Histronic Personality Disorder. The prejudicial term "hysterical" came from the myth that hysteria is a specific disorder of women.<ref name=Decker2013/>{{Rp|218}} (anxiety hysteria, conversion hysteria and subgroups)",[27]:11 diagnostic code 161 in the PSYCHONEUROSES section, which was directly mapped to four different but similar DSM-II diagnoses, including "300.14 Hysterical neurosisThe prejudicial term "hysterical" came from the myth that hysteria is a specific disorder of women.<ref name=Decker2013/>{{Rp|218}}Hysteria is an historic term which refers to several different disorders. The DSM-II (1968) listed "multiple personality" as a symptom of "Hysterical Neurosis, dissociative type". This later become Multiple Personality Disorder before being renamed to Dissociative Identity Disorder, retaining code 300.14, and becoming part of the Dissociative Disorders category along with Depersonzaliation Disorder (formerly Depersonzaliation Neuroses)."Hysterical Neurosis, conversion type" was listed under "Neuroses" in the DSM-II (code 300.13), and later became "Somatoform Disorder", but is now known as Somatization Disorder in the DSM manual, and Conversion Disorders in the ICD manual.<ref name=Decker2013/>{{Rp|612}} This represents physical symptoms which are common in dissociative disorders.Hysteria also refers to physical symptoms which are believed to have an unconscious psychological cause, for example Conversion Disorder. "Hysteria is still stigmatized and frequently associated with lying or malingering." However, symptoms are not under the person's voluntary control. (Cottencin, 2013)Hysterical Personality Disorder was renamed to Histronic Personality Disorder. The prejudicial term "hysterical" came from the myth that hysteria is a specific disorder of women.<ref name=Decker2013/>{{Rp|218}}, dissociative type",[27]:11 which included "multiple personality" as a symptom.[28]

From the 1950s, movie reviewers began looking for psychoanalytical concepts in movies.[7] In 1954 psychiatrists Corbett H. Thigpen and Hervey M. Cleckley published "A case of multiple personality"[31], writing the book "The Three Faces of Eve" in 1957 from their point of view as the patient's psychiatrists.[8] Also in 1957, an American film adaptation of this book, also called The Three Faces of Eve, was released. The subject of the case study, book and film was Chris Costner Sizemore, whose identity was not publicly known at the time. Actress Joanne Woodward won an Academy Award for the roles of Eve's three identities, Eve Black, Eve White and Jane in the film.[7] Sizemore's identity was revealed only in 1975; she wrote her autobiography "I'm Eve" in 1977,[32] followed by several other books about her recovery from DID, including her description of the integration of her identities in "A mind of my own" (1989).

1960 to 1980

Sybil-book.png

Herbert Spiegel (1963) was recognized dissociation as a defensive process, and as part of a conceptual framework; using a spectrum or continuum to describe the degree of dissociation. He saw the defensive nature of dissociation as a "fragmentation process that serves to defend against anxiety and fear (or instinctual demands)" and recognized its relationship with repressionFreud's term for an unconscious defense mechanism in which unacceptable mental contents are banished or kept out of consciousness; important in normal psychological development and in neurotic and psychotic symptoms formation. <ref name=Sadock2008/>{{Rp|29}}Repressed memory is a term mostly used by the False Memory Syndrome Foundation and their followers, that is meant to refer to when memories are willfully, although unconsciously, suppressed. This is not the same as dissociation. <ref name=Howell2011/>{{Rp|34-35}} Recovered memory refers to a memory that was forgotten and has now returned, usually of a traumatic nature.. [24] This was known as the dissociation-association continuum. Herbert Spiegel viewed dissociation as both the disintegration of otherwise associated ideas and the constriction of awareness.

The second edition of the DSM, known as the DSM-II, was published in 1966[27]; until being updated in 1980,[33] it referred to dissociative identity disorder as "Hysterical NeurosisThe prejudicial term "hysterical" came from the myth that hysteria is a specific disorder of women.<ref name=Decker2013/>{{Rp|218}}Hysteria is an historic term which refers to several different disorders. The DSM-II (1968) listed "multiple personality" as a symptom of "Hysterical Neurosis, dissociative type". This later become Multiple Personality Disorder before being renamed to Dissociative Identity Disorder, retaining code 300.14, and becoming part of the Dissociative Disorders category along with Depersonzaliation Disorder (formerly Depersonzaliation Neuroses)."Hysterical Neurosis, conversion type" was listed under "Neuroses" in the DSM-II (code 300.13), and later became "Somatoform Disorder", but is now known as Somatization Disorder in the DSM manual, and Conversion Disorders in the ICD manual.<ref name=Decker2013/>{{Rp|612}} This represents physical symptoms which are common in dissociative disorders.Hysteria also refers to physical symptoms which are believed to have an unconscious psychological cause, for example Conversion Disorder. "Hysteria is still stigmatized and frequently associated with lying or malingering." However, symptoms are not under the person's voluntary control. (Cottencin, 2013)Hysterical Personality Disorder was renamed to Histronic Personality Disorder. The prejudicial term "hysterical" came from the myth that hysteria is a specific disorder of women.<ref name=Decker2013/>{{Rp|218}}, dissociative type". The DSM-II classified both Hysterical neurosis, dissociative type and Hysterical neurosis, conversion type in the NEUROSES section, along with Depersonalization, Anxiety, Depressive and Obsessive Compulsive.[27] The DSM-II stated:

"In the dissociative type, alterations may occur in the patient's state of consciousness or in his identity, to produce such symptoms as amnesia, somnambulism, fugue, and multiple personality." The code 300.14 was assigned, which is used in the DSM-5 today.[34][28][35]:155
Sybil.png

The next popular media featuring dissociative identity disorder was "SybilSybil is a biography describing the life of a woman with dissociative identity disorder, published as a book in 1973 and released as a TV movie in 1976."It is often the first association that people have when they hear the words MPD or DID. Despite the Hollywood blitz associated with this disorder, however, the diagnosis appears to have begun in the last 1800s with Pierre Janet, a French psychiatrist, and William James, a student of philosophy and psychology." <ref name=Haddock2001/>{{Rp|12-13}} "Sybil" included descriptions of the severe abuse and sexual abuse she suffered during her childhood, and the help she received from her psychiatrist, Dr. Wilbur. <ref name=Schreiber1973/>Nearly 40 years later, after the death of "Sybil", a journalist published the heavily marketed book "Sybil Exposed" claiming Sybil did not have DID, but legal action forced the publishers of Sybil Exposed to remove a false statement on the dust jacket and provided additional evidence of false and fabricated statements in Sybil Exposed.<ref name=Suraci2011/> Coons (2013) later studied the original evidence and stated "the story of Sybil is true, not fraudulent or fiction". <ref name=Coons2013/> {{See also| History of DID}}," a biography published in 1973,[36] which described the life of a shy woman known as Shirley Ardell Mason, referred to as "Sybil" in the book. This included descriptions of the severe abuse and sexual abuse she suffered during her childhood, and the help she received from her psychiatrist, Dr. Cornelia Wilbur. The book Sybil describes dissociative amnesia, horrific sexual abuse and suicide attempts which Shirley made. It also describes how Dr Wilbur contacts "Sybil's" pediatrician and hears an account of the extensive scaring he found when he treated her for a bladder problem as a child. Dr Wilbur also visits Shirley's childhood home and sees the equipment that Shirley's mother had used to torture her as a child. The film "Sybil" was a TV movie released in 1976, with Sally Field winning an Emmy Award for starring in the lead role of Sybil[7]. The number of cases of dissociative identity disorder diagnosed sharply increased in the late 1970s and throughout the 1980s, which led to controversy.[7] Some professionals extremely skeptical of the diagnosis were found to be falsifying of clinical data[22], deliberately interfered with the clinical care of patients and repeatedly harassing patients and/or therapists.[37]

In the 1970s, Hilgard published his neodissociation theory (1977), studies by Ludwig et al. (1972) introduced contemporary scientific study of dissociation and further research on dissociative identity disorder led to the separate section for dissociative disorders in the DSM-III (published in 1980). Also in 1980 Bliss, Coons, Greaves and Rosenbaum published landmark articles, beginning a huge increase in the rate of diagnosis for DID. Rosenbaum's article "The role of schizophrenia in the decline of diagnoses of multiple personality" [22] [38]:171

1980 to 1993

Minds-of-billy-milligan.png

The DSM III psychiatric manual, published in 1980, renamed DID to Multiple Personality Disorder; for the first time this was a separate diagnosis rather than one of a number dissociative symptoms grouped together as one diagnosis. The book the "Minds of Billy Milligan" was published in 1981, and adapted to cinema as The Crowded Room in 2008.(citation needed) In 1986 and 1997, Lipton investigated the presence of two adult personas within an individual, one good and one bad, this phenomena he referred to as "doubling", describing it as:

A process called "doubling" is described as a division of the self into two functioning wholes. [39]

Doubling is a mechanism whereby a person could deny the reality of their harmful deeds whilst appearing to family and friends as a good and respectable person; he described it as a way for a person involved in genocide to avoid guilt. [39] He made a clear distinction between doubling and Multiple Personality Disorder and that the origins and symptoms of both conditions were different. Doubling has never been a psychiatric diagnosis and avoids rather than causes distress.

The DSM III also classified "Multiple Personality Disorder" in the Dissociative Disorders section, not in the Personality Disorders section. It was also known as multiple personality disorder in the World Health Organization's ICD manual[40]. By 1980, there were 200 diagnosed, reported cases of dissociative identity disorder, increasing to 20,000 from 1980 to 1990. The first scholarly monographs on the topic appeared in 1986.(citation needed)Interpersonality amnesia was removed as a diagnostic feature when the DSM-III-R was published in 1987, which may have contributed to the increasing frequency of the diagnosis. The DSM]-III-R made alterations to the wording of the diagnostic criteria, which reflected the increased understanding and research into the disorder.[33]. This included referring to alters as "personalities" or "personality states"[33].

1994 to 2000

Multiple personality disorder was renamed to its current name of Dissociative Identity Disorder in 1994, when the the DSM-IV was published.[30] In the mid-1990s scientific publications regarding Multiple Personality Disorder appeared to peak then rapidly decline, however this was partly due to some papers being overlooked by those disregarding the new term Dissociative Identity Disorder which was used in the American DSM from 1994, but not the World Health Organization's ICD manual. Over the longer term research of the disorder has increased rather than declined, and a wide variety of peer-reviewed international research is now available for dissociative disorders including DID.[41]

In 1994, the DSM-IV replaced the criteria again and changed the name of the condition from Multiple Personality Disorder to the current "Dissociative Identity Disorder" to emphasize the importance of changes to consciousness and identity rather than personality. The inclusion of interpersonality amnesia helped to distinguish Dissociative Identity Disorder from unspecified types of dissociative disorders, but the condition retains an inherent subjectivity due to difficulty in defining terms such as personality, identity, ego-state and even amnesia.

The ICD-10 still classifies Dissociative Identity Disorder as a "dissociative [conversion] disorder" and retains the name "Multiple Personality Disorder" with the classification number of F44.8.81.[40]

2000 Onwards

In 2007, another film named "Sybil" was produced based on the 1973 book. After Shirley's death, controversial journalist Debbie Nathan published "Sybil Exposed" (2011) in an attempt to discredit Sybil's diagnosis as a hoax created by a manipulative psychiatrist; despite the fact Shirley Mason never recanted. This book relied heavily on telephone calls for references, and Shirley's close family were not interviewed.[42] Prior to this publication, Nathan was well know for her strong views opposing Dissociative Identity Disorder and her many attempts to discredit survivors of ritual abuse, she has also been linked with the False Memory"Memory is not a static thing, but an active set of processes." <ref name=Siegel/>{{Rp|51}} "Our earliest experiences shape not only what we remember, but also how we remember and how we shape the narrative of our lives. Memory can be seen as the way the mind encodes elements of experience into various forms of representation. As a child develops, the mind begins to create a sense of continuity across time, linking past experiences with present perceptions and anticipations of the future." <ref name=Siegel/>{{Rp|11}} Syndrome Foundation. Also in 2011, Patrick Suraci Ph.D, a licensed psychologistPsychologists usually have an advanced degree, most commonly in clinical psychology, and often has extensive training in research. Psychologists use psychotherapy (often referred to as "talk therapy" or just "therapy") to treat mental disorders. Some psychologists specialize in psychological testing and evaluation.<ref name=AboutPsychiatry/> who knew Shirley, but never treated her, published "SYBIL: In Her Own Words The Untold Story of Shirley Mason, Her Multiple Personalities and Paintings"[43] with the support of Naomi Rhodes, Shirley's closest living relative. After the publication of Nathan's book, legal action by Suraci forced publisher Simon and Shuster to correct a false statement on the dust jacket; Suraci also provided additional evidence of false and fabricated statements included in the book, these can be viewed online.[44] These were later verified by others.[43] Suraci's book SYBIL: In Her Own Words includes copies of Shirley's art work, which reflected how she saw herself. Coons (2013) confirmed "the story of Sybil is true, not fraudulent or fiction". [5]

The DSM-5 published in May 2013 maintained the diagnosis of Dissociative Identity Disorder, making only minor changes to the criteria.

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