Have any of you actually, truly, honsetly, seen someone with DID

[BuckeyeLove]

...or has it just been cluster b stuff, or a feigner if in a forensic context. Cuz that's been my experience.

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[WisNeuro]

I've seen it maybe a dozen times in a patient's chart over the years (recently evaluated one). In my interactions with the patient's, there was never anything that convinced me that the diagnosis was accurate. And, at least in the neuro sense, the evals are usually invalid.

 

[PsyDr]

Never seen one. Never met a reputable practitioner who has seen one.

That one poster who didn't like me thought phdstudent and I were the same person, so maybe I'm Tyler Durden'ing myself.

 

[cara susanna]

I've seen dissociation, not DID. I do know other practitioners who've seen DID.

 

[Fan_of_Meehl]

...or has it just been cluster b stuff, or a feigner if in a forensic context. Cuz that's been my experience.

Can't say that I have. But I can offer a reference (book chapter, really) that is the single most impressive thing that I've ever seen written about DID and it's written from a cognitive-behavioral case formulation perspective and the authors crafted a very sophisticated treatment plan utilizing evidence-based principles for behavior change (and documented progress in a single-case design type paradigm).

It's a chapter in the (phenomenal) book:
O'Donohue, W. & Lilienfeld, S.O. (2013). Case studies in clinical psychological science: Bridging the gap from science to practice. Oxford: New York.
Ch. 13 in that book (pp.329-360) is entitled, The Treatment of Dissociative Identity Disorder:Questions and Considerations.

 

[cara susanna]

Can't say that I have. But I can offer a reference (book chapter, really) that is the single most impressive thing that I've ever seen written about DID and it's written from a cognitive-behavioral case formulation perspective and the authors crafted a very sophisticated treatment plan utilizing evidence-based principles for behavior change (and documented progress in a single-case design type paradigm).

It's a chapter in the (phenomenal) book:
O'Donohue, W. & Lilienfeld, S.O. (2013). Case studies in clinical psychological science: Bridging the gap from science to practice. Oxford: New York.
Ch. 13 in that book (pp.329-360) is entitled, The Treatment of Dissociative Identity Disorder:Questions and Considerations.

I saw a video at a DBT training of a patient with DID and how they treated the patient behaviorally. It was fantastic!

 

[Fan_of_Meehl]

I saw a video at a DBT training of a patient with DID and how they treated the patient behaviorally. It was fantastic!

From the (intro) chapter:
"In this chapter, we provide a case study of a "Ms.M," a 49-year-old Caucasian woman who presented with symptoms of DID and was successfully treated with a multifocal cognitive behavioral intervention that included methods derived from dialectical behavior therapy and acceptance and commitment therapy. We first present the posttraumatic model (PTM)of dissociation, which serves as a backdrop against which to view both the traditional treatment of DID and the controversies that have dogged DID from the time of Freud to the present. We present this introductory information to bring into relief the sharp contrasts between the conventional treatment of DID, which we eschew, and the empirically based approach that we adopt in the case at hand. More specifically, we propose that evidence-based methods can be implemented to treat the emotional dysregulation and manifold symptoms that accompany the typical presentation of DID. In contrast, we contend that treatments with a sole or major focus on trauma provide a cautionary example of how *not* to treat patients with DID, and that they serve as a counter-point to empirically grounded treatments, which we favor and recommend to the reader."

It's a real intellectual 'tour-de-force' of the clinical science approach to practicing psychotherapy and is, to me, beautiful work.

 

[Justanothergrad]

I saw someone (my time was extremely limited with the client) who claimed to have DID in a non-forensic setting. It was part of an ACT unit. Some psychologists/Social Workers/psychiatrists in the agency believed it. Others didn't. There was lots of dissociation. There was also lots of BPD. I'm not sure I had enough time to make a really make a firm opinion on it, but in general with such low base rates (best case) and so many other explanatory factors I always leaned towards "nope" myself.

 

[psychrat]

I've seen it maybe a dozen times in a patient's chart over the years (recently evaluated one). In my interactions with the patient's, there was never anything that convinced me that the diagnosis was accurate. And, at least in the neuro sense, the evals are usually invalid.

Ditto. I met a few patients who were diagnosed, but was not convinced at all after meeting with them.

 

[calimich]

no to DID, although I worked with an adolescent boy for a while in PP who met criteria for depersonalization/derealization disorder...he referred to it as "the flip-up feeling"

 

[Therapist4Chnge]

Never a (legit) case of DID, but plenty of patients w. strong Cluster B and reasons why that diagnosis benefited them.

 

[psych.meout]

What's the empirical basis for the symptoms of DID? How is it that switching between "alters" allows access to certain memories or thought processes and not others? What is the neurobiological basis for this?

Similarly, how are there changes in "personality" and are these actual traits changes or just such wild emotional dysregulation (e.g., BPD) that it looks like personality change to people who are looking for it (i.e., a priori)?

It sure seems DID proponents have a lot of 'splainin' to do about why these things conflict with what we know about how the brain, personality, and other psychological concepts work.

 

[smalltownpsych]

I did have one patient who met most of the criteria for DID. She had the loss of time, change of personality, and was one of the most fascinating cases that I ever worked with. I was very skeptical going into the case when I saw DID as one of the dx'es, but I was eventually convinced. In my mind it is really just an extreme variant of Borderline PD. She also did not tell people that she had DID or multiple personalities as have the rest of the patients that I have met who didn't really have it. She actually disputed it a bit and I agreed that conceptualizing as different aspects of herself and mood states was more helpful than concretizing the splits and dissociation into something more.

 

[AppsAintNoThang]

I think we have a sample size of younger generation psychologists on here. This assertion isn’t tough to swallow since it is an Internet forum and all. The history of DID, from my understanding, peaked in popularity around times of the movie Sybil and other media portrayals. I’m also personally of the belief that our knowledge of complex trauma/dissociation/personality disorders has come a long way since then. We no longer prompt that presentation through our work with patients. Interesting to think what diagnoses we may be expecting or prompting these days, though.

I know many of my older generation supervisors will insist they’ve worked with patients with DID. The lack of evidence of it being a unique, true diagnostic presentation leaves me just saying, “yeah, maybe. But probably not.”

 

[erg923]

Not really an area/diagnosis that is talked about during graduate school, in my experience. I have Sybil on the home-office bookshelf. That's about all I know.

Hashbrown: Occam's Razor.

Hashbrown: Parsimony

 

[deleted343839]

I once saw a patient who had a lengthy psychiatric hospitalization for bipolar I (late 80s I think) and came out with a diagnosis of DID and some disturbing "recovered memories." At least by the time they reached me, the patient was pretty high functioning given the circumstances and I never saw clear evidence of a dissociative disorder.

 

[Therapist4Chnge]

The closest case I saw included multiple decades of sexual abuse and drug abuse, on top of BPD, PTSD, bulimia, and drug induced mania. The person would disassociate and become aggressive, otherwise they were very docile. Fascinating case, but also very sad; I do not miss SMI cases.

 

[AcronymAllergy]

I've seen a small handful of folks with the diagnosis, and how they've arrived there is usually just as variegated and convoluted (RE: conceptualizations of their prior MH professionals) as their clinical histories. In all the cases I've seen where it's been in their history, there's been a very strong identification with the diagnosis.

 

[BuckeyeLove]

Thank you all for your input. I really do appreciate it. I'm wondering further, have any of you ever heard of it being diagnosed in, let's say, children? And also, have you ever heard of someone who is dx with it being able to accurately and fluently recall everything that happens while they are an alter? or of them talking to their alters, like conversing with them? But then the alter itself only comes out when no one else is around (i.e., conveniently "when I'm alone in my bedroom" but also conveniently at the time of committing a bad act before).

I was always under the impression that, 1. they don't usually talk with their alters, 2. they don't usually recall in great detail what they did when in an altered state, and 3. if this disorder is real, it's symptoms would wax and wane similar to other disorders, and not be so consistent as to only show up conveniently at times when you are alone (....and also one time previously where you may have committed and act and are now blaming said act on your DID).

 

[WisNeuro]

Speak of the devil, and he shall appear. Just got my 2nd DID pt in the past 2 months referred. Although, apparently the alters only come out to verbally abuse family members. I'll let you know how the PVT/SVT testing goes.

 

[AcronymAllergy]

I've had a pt with previously-diagnosed DID say that they sometimes could recall what happened (e.g., like watching from outside of themselves), but not always. I think it may have depended on which alter was involved.

 

[PsyDr]

I would think that the behavioral understanding of personality, recent research that indicates personality changes over a lifetime, sciences understanding of memory, neuro anatomy, electrophysiology, that this has never been induced by an organic pathology such as tumor, general neuroscience to include stuff that won a nobel, and Sybil herself saying it was faked for both treatment compliance and financial necessity would be good evidence for this not being a real diagnosis.

You have to keep in mind that when this blew up world reknown psychiatric hospitals had entire units devoted to this diagnosis and for victims of ritualistic satanic abuse. Large lawsuits resulted including some of the largest malpractice cases in psychology history.

 

[WisNeuro]

Preaching to the choir for most of us, I imagine.

 

[WisNeuro]

Welp, already failed 2/2 of my initial PVTs. So, I have still never had a "MPD/DID" pt pass validity tests.

 

[smalltownpsych]

Could I just say that I really hate the term "alters". Even the patient that I had who was closest to meeting criteria for this diagnosis and didn't appear to be feigning or exaggerating did not have truly separate personalities. Also, I wonder if she would have passed a validity test. She had been tested by a previous intern a few years before I saw her. Can't really recall what tests he used. He was the one who initially diagnosed with Dissociative Disorder NOS. She was quite an interesting case. All emotional distress was dissociated from and she would casually flit about the inpatient unit like Doris Day (I could almsot see her breaking into Que Sera Sera), then at times would dissociate and harm herself in dramatic ways. Then later would again have a placid and friendly demeanor. It was kind of cool to watch, although some of the harm was a bit creepy. Not just your standard "cuts on the forearm or legs" type stuff. Interestingly she had four or five different names, but also had rational reasons for them including her parents calling her three different names even when she was growing up. She didn't attach personalities to them though.

 

[BuckeyeLove]

Again, thank you all for the input. I am currently having to clean up someone else's mess. A mess which has subsequently caused a lot of drama. Ive been overthinking everything and reviewing records/interviews for 2 days straight and am pretty fried.

 

[PsyDr]

Again, thank you all for the input. I am currently having to clean up someone else's mess. A mess which has subsequently caused a lot of drama. Ive been overthinking everything and reviewing records/interviews for 2 days straight and am pretty fried.

Maybe that someone else is actually you...

 

[Fan_of_Meehl]

Again, thank you all for the input. I am currently having to clean up someone else's mess. A mess which has subsequently caused a lot of drama. Ive been overthinking everything and reviewing records/interviews for 2 days straight and am pretty fried.

Hard truth #99 they never told me in grad school: if you try to uphold scientific and professional standards in differential diagnostics, assessment, or treatment planning (when the truth offends or upsets someone)...your life is gonna be far more difficult and painful. But, on the bright side, you can sleep at night.

 

[traumamama]

I have not, although I've seen different "self-states" and regression.I have seen BPD ct's go from "good" to "bad" version of themselves, but remain aware of their behaviors.

 

[ClinicalABA]

During graduate training, we had a local psychologist come in to speak to us about her private practice. She held herself out as an expert in DID, and claimed that it was a very common conditions, affecting "dozens" of clients in her practice (located in town with a population of 25K. She also said that she kept a bat under her desk, in case an "alter" became violent. I remember most of us shooting sidways glances to each other to convey how ridiculous this all seemed (there were one or two students who thought it was the coolest thing ever and sat raptured for the whole time she told us her pretty far out stories of different "multiples" she worked with).

I had one client during training (who I was seeing as part of a couples counseling case) who self-identified with DID. It all seemed operant to me (e.g., talk in kid voices immediately whenever difficult topics came up; go back to "normal" voice as soon as topic changed). It stopped happeing altogether during our sessions after a few weeks- a fact I attributed to my not acknowledging or responding differentially to them).