A Professional Educator’s Guide to Dissociative Identity Disorder

(Infographic Below)

Finding accurate information on DID as a professional educator can be challenging due to widespread misinformation and under-recognition. Use this guide to help inform your curriculum and your practice.

DID Systems are incredibly vulnerable

Approximately 61%-72% of DID patients attempt suicide, and 34-38% engage in self-harm (Brand, 1997). Samples of people with high levels of trauma have also been related to increased substance abuse, risky sexual behavior, and decreased life expectancy (Felitti et al., 1998). This is why educators must be informed about the condition and spread scientifically supported information to future clinicians.

DID patients are waiting >3 years for diagnosis

25% of dissociative disorder patients had >10 years delay to get a diagnosis, and 57% had a > 3-year delay (Leonard et al., 2005). This is striking compared to the 1.3 year average for anxiety and mood disorders (Jorm, 2012).

DID Myths Vs. Facts

Myth

• Therapists create DID, and acknowledging alters makes symptoms worse.
• DID is overt, you can easily tell when a person has it.
• DID is incredibly rare.
• DID is a dubious condition.
• Integration is the only proper treatment for DID.

Fact

• DID is formed from trauma and can only be successfully treated by acknowledging alters (5th ed.; DSM–5; American Psychiatric Association [APA], 2013; Brand et al., 2014).
• DID is primarily covert, which is why the DSM-V criteria was expanded to include self-reported identity states (APA, 2013).
• DID affects approx. 1.5% of the population, or ~5 million Americans (APA, 2013).
• DID is well-established in research and can’t be replicated fictitiously (Brand & Chasson, 2015).
• Integration can be beneficial but not practical or possible in all cases (Ringrose, 2011).

The Iatrogenic/Sociocognitive Model is Harmful and Demonstrably False

Only 55% of clinicians believe DID is a valid diagnosis despite scientific evidence (Leonard et al., 2004). It’s no surprise that there are considerable delays in diagnosis and treatment.

Edit: 40% of clinicians were unable to identify DID from a clinical vignette. This directly correlated with their skepticism of the disorder (Perniciaro, 2014). It’s no surprise that there are considerable delays in diagnosis and treatment.

The false belief of DID as an iatrogenic condition has led to under-diagnosis, rampant misinformation, and lack of research. There are no excuses for clinicians or educators to assert this belief still, considering the extensive literature supporting the trauma model and disproving the socio-cognitive (APA, 2013; Brand et al., 2014; Loewenstein, 2018).

Conclusion

It can be challenging to get accurate information as a professional educator on Dissociative Identity Disorder with the medical and cultural attitudes surrounding DID and the lack of research and education. As a professional educator, you directly influence the way future clinicians will treat patients with the disorder, which is why it’s essential to ensure the information is accurate. DID is a valid, scientifically supported disorder that is more common than many clinicians believe. DID patients are vulnerable and experience significant delays in treatment which actively harms this population. Luckily, as an educator, you can help change the stigma around DID and support it as a traumagenic condition, assisting in shaping the future of DID research and treatment.

References

American Psychiatric Association. (2013). Diagnostic and Statistical Manual of Mental Disorders, 5th Edition: DSM- 5 (5th ed.). American Psychiatric Publishing. https://doi.org/10.1176/appi.books.9780890425596.dsm08

Brand, B. (1997). Establishing Safety with Patients with Dissociative Identity Disorder. Journal of Transnational Management Development, 2(4), 133–155. https://doi.org/10.1300/j130v02n04_07

Brand, B. L., & Chasson, G. S. (2015). Distinguishing simulated from genuine dissociative identity disorder on the MMPI-2. Psychological Trauma: Theory, Research, Practice, and Policy, 7(1), 93–101. https://doi.org/10.1037/a0035181

Brand, B. L., Loewenstein, R. J., & Spiegel, D. (2014). Dispelling Myths About Dissociative Identity Disorder Treatment: An Empirically Based Approach. Psychiatry: Interpersonal and Biological Processes, 77(2), 169– 189. https://doi.org/10.1521/psyc.2014.77.2.169

Felitti, V. J., Anda, R. F., Nordenberg, D., Williamson, D. F., Spitz, A. M., Edwards, V., Koss, M. P., & Marks, J. S. (1998). Relationship of Childhood Abuse and Household Dysfunction to Many of the Leading Causes of Death in Adults. American Journal of Preventive Medicine, 14(4), 245–258. https://doi.org/10.1016/s0749- 3797(98)00017-8

Jorm, A. F. (2012). Mental health literacy: Empowering the community to take action for better mental health. American Psychologist, 67(3), 231–243. https://doi.org/10.1037/a0025957

Leonard, D., Brann, S., & Tiller, J. (2005). Dissociative Disorders: Pathways to Diagnosis, Clinician Attitudes and Their Impact. Australian & New Zealand Journal of Psychiatry, 39(10), 940–946. https://doi.org/10.1080/j.1440- 1614.2005.01700.x

Loewenstein, R. (2018). Dissociation debates: everything you know is wrong. Controversies in Psychiatry, 20(3), 229– 242. https://doi.org/10.31887/dcns.2018.20.3/rloewenstein

Perniciaro, L. A. (2014). The influence of skepticism and clinical experience on the detection of dissociative identity disorder by mental health clinicians

Ringrose, J. L. (2011). Meeting the needs of clients with dissociative identity disorder: considerations for psychotherapy. British Journal of Guidance & Counselling, 39(4), 293–305. https://doi.org/10.1080/03069885.2011.564606