Thing you don’t find out from an Abnormal Psychology courses

Violence & Dissociative Identity Disorder – any link, or just stigma?
There’s no link between having DID or any other mental disorder and being violent or committing violent crimes. The only exception is Anti-Social Personality Disorder (and even this is an optional criteria), this disorder only rarely occurs in people with DID. Sources: Mental Illness and Violent Behavior: The Role of Dissociation (2017) in Statement on Split by ISST-D, Peterson, Skeem et al. (2014) in Mental illness not normally linked to crime, DSM-5 p659 ASPD criterion A.
Being a victim of violent crime – especially physical abuse/assault and sexual abuse or rape is extremely common in people with DID. Self-inflicted violence e.g., self-harm and suicide attempts occur in 40-60% of people with DID (source: DSM-5).
Stigma? Extremely common – e.g., this scientific article in a newspaper has a picture with a caption “psychopaths” – a term irrelevant to DID but suggesting violence and crime.
Now, to the “Split” movie Dissociative Identity Disorder quiz…

Click as many answers as you like for each question – correct answers go green, wrong answers go red. There’s no total score to worry about.

Further links and research for questions

Question 4 – blindness with alters that can see and blindness caused by psychological trauma – videos & cases
Real cases of transient blindness, with and without DID: Blind woman who switched personalities could suddenly see (2013), / Sight and blindness in the same person: original research, 2015 (PMID: 26468893 DOI: 10.1002/pchj.109) / 2007 summary. Diana, with her blind alter personality Margo, and her sighted alter personality Corey.

A case study in Eastern Congo, Africa, in 2011 found this kind of dissociative and transitory blindness among women traumatized by extreme sexual violence.15 year old girl in Ethiopia

Somatoform Dissociation Questionnaire (scroll down for the SDQ-20)

Question 8- Example cases of amnesia for a major trauma include:

• Witnessing a murder, recalled years later, allowing police to identify the previously unidentified victim
• Cases of child sexual abuse witnessed by other adults or victims who they never forgot
• a significant percentage of cases of sexual abuse or rape which involved hospital treatment at the time but couldn’t be recalled later (LM Williams, 1995)

• See also: The Recovered Memory Project

• Dissociative Amnesia – Soldiers witnessing another soldier’s trauma: which the soldier denies all memory of – previously called psychogenic amnesia – is well documented among combat troops (see DSM-5 p300, and Trauma-induced dissociative amnesia in World War I combat soldiers (van der Hart, Brown, & Graafland, 1999)

• Holocaust survivors who were held in concentration camps having not a single memory of it (link above)
• Dissociative Amnesia – a case of losing all memory of finding the body of a loved one after their sudden death (video, may be distressing to watch)
• Posttraumatic Stress Disorder – an optional criteria of PTSD is forgetting a “significant part of the trauma” typically due to “dissociative amnesia”(source: DSM-5, PTSD criteria D.1)
• People without a specific mental disorder who were abused or traumatized as children, particularly physically or sexually, are known to spontaneous recall such a memory
• Historical examples from literature also exist, including the Parisian opera Nina (1786) by Dalayrac and Marsollier, in which the heroine forgets seeing her lover apparantley killed in a duel and still waits for him daily – then won’t accept it is him when he does later appear.
• Somatoform Dissociation Questionnaire (scroll down for the SDQ-20) – physical problems common in people with DID

Question 9 – Animal alters

Smith (1989) describes a 70 year-old Native American with many alter personalities which see themselves as animals or spirits – unsurprisingly they aren’t evil serial killers either.
See also: Alters in DID

Question 10 – Why it’s very difficult to pretend to have Dissociative Identity Disorder to clinicians – besides biological/physical testing

• As it mentions in “Split”, people with Dissociative Identity Disorder spend an average of 7 years in the mental health system before being diagnosed with DID – typically have have a series of misdiagnosis. If many clinicians have neither training or experience diagnosing any dissociative disorders, they aren’t likely to give the diagnosis to someone realistically acting out the symptoms either. But the actors may be diagnosed with schizophrenia, psychotic disorders, borderline personality disorder, or bipolar disorder by mistake – and possibly medicated for them. Even if the actor told a clinician they believed they had Dissociative Identity Disorder/multiple personalities that often won’t lead them to asking relevant questions for diagnosis – they may assume you just want to be a “special” or “interesting” case, or maybe you should be assessed for histronic personality disorder (which involves dramatic, exaggerated behavior). Not until the 2013 publishing of the DSM-5 could people’s self-reporting of DID symptoms count (self-reporting Depresson, Bipolar symtpoms etc, was fine though) – the person had to switch to an alter personality in front of clinical staff (reports and descriptions from partners were ignored). Having an alter personality turn up for the assessment didn’t usually because it wasn’t a “switch” being observed.People professional diagnosed and be told by friends or family that “you don’t have that” or “nobody has that” because they don’t present symptoms that fit the stereotype, or because they don’t “match” movies about real people with DID like Sybil. Check out Truddi Chase’s interviews on Oprah, and see if you can spot her DID symptoms… of course, she might not actually “switch” to an alter personality when on camera.
• Dissociative Identity Disorder (like other mental health conditions) shouldn’t be diagnosed just be observing someone – which is what happens in the movie Primal Fear – the character of Aaron Stampler was acted so brilliantly that Dissociative Disorders specialist Dr Bethany Brand commented on how realistic it was to watch… but clinical assessment has a set of well-validated screening tools and diagnostic interviews available for clinicians which can be used to check for faking DID.
• Dissociative Identity Disorder is a hidden disorder – like all the other dissociative disorders, unless symptoms are continually obvious (which only applies to about 4% of people with it), or the person has a short period of more obvious symptoms (as shown in the movie “Split”) – there won’t be much to act: it’s behavior-based symptoms are subtle, and most clinicians don’t ask about dissociative symptoms or amnesia
• It’s not difficult to memorize answers to standard questionnaires – but the clinician might never give you a questionnaire, and if they do then questionnaires aren’t diagnostic tools. Questionnaires (e.g., the Dissociative Experiences Scale) are screening tools – they simply signal to the clinician that a clinical interview for dissociative disorders would be appropriate/helpful – they give a range of scores in which DID is highly unlikely, or fairly likely to be present in many people with those scores.
• Supposing you get to a clinical interview, and the clinician is knowledgeable about Dissociative Disorders. There’s only two well established clinical interviews, but one has over 100 questions – without a “total score” to aim for, and the other takes around 90 minutes and the scoring information (i.e., the range of ‘correct’ answers isn’t publically available). Supposing the actor did manage to get a set of appropriate answers (there are many different combinations, since DID isn’t the same for everyone), those answers would need to be memorized and repeated at the same time as making subtle movements which indicate some dissociation is taking place – at the same time as not actually looking like you are trying to remember anything. To practice the interview questions you’d need get a copy first, which you have to buy for and they are only given to people who can prove their clinical qualifications in the first place, academic qualifications alone aren’t enough!
• Part of assessing for any mental disorder – including Dissociative Identity Disorder – involves taking into account current and recent life circumstances. If this acting is being done to fake a disorder in order to avoid a criminal conviction, this will mean a “forensic” assessment gets added – and DID is hardly ever counted as a legal defense anyway (in contrast to psychotic disorders, which are accepted as a legal defense if several enough) – not exactly like the movie Primal Fear then. Motivated faking of Dissociative Identity Disorder or truly believing you have it when you don’t (“simulated DID”) both have many indicators, e.g., (e.g., Thomas, 2008) that would be difficult to fake.
• Note: Some poor “teaching” about Dissociative Identity Disorder involves role playing alters, which is mistaking DID for a primarily behavior-based disorder, students may find their memory poor as they act different roles – which is called “state-dependent memory” and exists in non-DID people: it’s easier to remember events when you are in the same emotional state as when the event happened. After, they write up their “experiment” using their memory of it (none will have amnesia for everyday events like many people with DID do, so this won’t be a problem), and they will never have these “symptoms” again… because of course, the symptoms were acted rather than genuine. Faking DID behaviors won’t lead to the students going home and not recognizing their room mates, not remembering the year they were born, or find themselves covered in blood because an alter personality self-harmed without their knowledge. They won’t “come round” several hours later and not know whether they remembered to eat dinner – or whether an alter personality remembered and ate it for them. This “role playing” is actually an example of stigma: it would be totally insulting to “act out” a more familiar disorder like depression by “looking sad and lethargic” for a while, but DID is often treated without compassion and as a “fun” or “entertaining” practical exercise. Even worse, this leads to the assumption that if only someone with DID could “snap out of it” and “behave normally” the whole condition would go away – which doesn’t work for any mental disorder – because it’s not a choice.

Further Information about Dissociative Identity Disorder

Statement on Split by the International Society for the Study of Trauma and Dissociation (ISST-D, 2017)

Separating Fact from Fiction: An Empirical Examination of Six Myths About Dissociative Identity Disorder – Brand (2016)

Dissociative Disorders: An Overview of Assessment, Phenomonology and Treatment A 10 page Dissociative Identity Disorder and Dissociative Disorders summary from the Psychiatric Times, comparing DID with Borderline Personality Disorder, Schizophrenia and Bipolar

Dissociative Identity Disorder Treatment Guidelines for Adults (ISST-D, 2011) – search this 80 page document for everything you ever wanted to know about DID

Dissociative Identity Disorder in the DSM-5 – 10 pages including the diagnostic criteria (APA, 2013, from p580 via google books preview)

Jeanne Fery: A sixteenth-century case of dissociative identity disorder

Know someone you think is faking having Dissociative Identity Disorder? Read Holly Gray’s excellent blog