Part 5: Recommendations

Diagnosis of DID is very rarely made on the first encounter between the clinician and the patient. Remember that depression is found in almost every patient walking into a psychiatrist’s office seeking help! We must distinguish between depression as a complaint/symptom and depression that is a disorder responsive to antidepressants.  The distinction is not easy and is often left to the psychiatrist’s own discretion or bias. 

Because of this, I cannot overemphasize ensuring that you maintain an appropriate diagnostic index of suspicion when meeting with patients.

Popular books and movies such as the three faces of Eve, Sybil, and the United States of Tara have given the public the wrong impression of DID.  Further, DID has suffered a great deal of negative publicity which negative publicity was promoted through litigation involving the now defunct False Memory Foundation. While I am happy that such Foundation is no longer operating, the negativity and doubt it sought to promote continues to impact acknowledgment of DID. The inclusion of the word “controversial” in news reports about DID is a most unfortunate artifact of those efforts.

For example, the incidence of incest was grossly under-estimated for decades until a study reported in a 1988 study in Finland about incest.   Girls reported incest experiences with their biological father at a rate of 0.2% and while girls living with a stepfather reported a rate of 3.7%. This is much more realistic than the extremely low figure often quoted for generations in psychiatry before. Bessel Van der Kolk and Judith Herman have written on childhood trauma in ways that opened the eyes of society to the impact of trauma which has been grossly neglected for years.   It is time for psychiatrists to wake up and reconsider the role of childhood trauma in every patient we encounter. 

We must continue to push back against the notion that DID is a controversy because it isn’t. DID is a condition that results in much dysfunction, pain and suffering. But because we are drawn to the dramatic, in movies and books, we have forgotten the tragic aspect of the human suffering in living breathing people who have experienced or are experiencing DID. 

Therapeutic training must include understanding both the incidence and the etiology of trauma and dissociation. In other words, pay attention to the symptoms of early childhood trauma. No fancy drama details are needed to assess the condition. Just pay attention.