The Complexity of DID
Dissociative Identity Disorder (DID) is such a complex and
highly controversial diagnosis in the field.
There are many in the medical community who deny its existence and even
some in the field of mental health who are skeptical. Despite the skepticism, it continues to find its
way into the DSM and into our offices.
As a professional, I admit having a mostly healthy fascination with this
disorder. Early on in my career I began
focusing most of my practice in trauma, and therefore have probably seen more
than the average number of clients who would fit into the category of having
DID. Once you’ve seen this disorder play
out, it’s hard to hold on to the skepticism and disbelief. Believe me!
I find it so unfortunate that a lot of the individuals with
DID who come to my office, have been through years of facilities, multiple diagnosis,
and various therapies which has been in so many ways more harmful than helpful
to them. Clinicians who work with
trauma, specifically complex trauma, are ethically bound to know the signs of
DID. This will allow for quick, accurate
diagnosis that can then make smooth the decisions of treatment planning,
treatment placement, and scope of practice.
Colin A. Ross, recently published an article in the Journal of EMDR
Practice and Research, about how to notice the signs of DID and accurately
diagnose. Below are the early indicators
Dr. Ross identifies for when to suspect DID.
For diagnosis, I have referenced the article below for further reading.
When to Suspect DID
1. Trauma History - A reported history of extensive, severe
childhood trauma (which does not have to be corroborated). This trauma does NOT have to include sexual
abuse
2. Borderline Personality Disorder –
Prior diagnosis of BPD, criterion for BPD currently met or subthreshold. It is common for depression and PTSD to be
comorbid with BPD.
3. Voices- Auditory hallucinations
which are usually chronic. The voices
may or may not have names and ages and often meets DSM-IV Criterion A for
schizophrenia.
4. Blank Spells- Discrete periods
of missing time lasting anywhere from minutes to days (without use of drugs,
alcohol, or medical condition).
5. Switching- Sudden changes in
behavioral state
6. Prior Diagnoses – Extensive history
with the mental health system, numerous prior diagnosis often including: BPD,
bipolar disorder, schizophrenia, schizoaffective disorder, PTSD, substance
abuse.
Ross, C. A., (2015) When to Suspect
and How to Diagnose Dissociative Identity Disorder. Journal of EMDR Practice and Research, 9(2),
114-118.
As you continue in your practice, learn to see the signs
that further assessment is needed for the possibility of DID. Some helpful assessments include the Dissociative
Experience Scale (DES), Dissociative Disorders Interview
Schedule (DDIS) , and for children/adolescents the Child
Dissociative Checklist.
Accurately recognizing and diagnosing DID can be such a
relieving experience for clients. It
also helps you, the clinician, make the best possible decisions for the client
about treatment moving forward. For more
information on this article see Ross, C. A., (2015) When to Suspect
and How to Diagnose Dissociative Identity Disorder. Journal of EMDR Practice and Research, 9(2),
114-118.
