As I have repeatedly pointed out in my blog and books, DID is a severe disorder affecting between 1 to 1.5% of the general population. According to a 2023 summary article concerning French psychiatrists’ views of DID, https://www.medscape.com/viewarticle/988814#vp_2, about 50% of psychiatrists in France have strong doubts about whether DID exists or not, despite their awareness that it is included in DSM-5.
According to this article, even though ½ of the psychiatrists have strong doubts about DID, 80% of them do not believe that patients are pretending or faking symptoms. This is at least one step in the right direction. It means that at among group participating in this French study, the odds are in favor of someone with DID meeting a psychiatrist who will not automatically deny their symptoms. Given that the initial barrier to any therapeutic alliance arises when a patient feels that the psychiatrist does not believe them, this is positive news.
The more that DID individuals engage with psychiatrists who are take their symptoms seriously, the more quickly DID will become acknowledged to be as common as schizophrenia rather than be seen as a rare disorder. If 50% of the psychiatrists in a country understand that DID is a legitimate diagnosis per DSM-5, the odds are so much better than in the past that a patient will find a psychiatrist that at least has DID in his/her index of suspicion for diagnoses. Again, positive news.
It is instructive that over 60% of those psychiatrists stated that they had not been trained regarding dissociative disorders. Of those that were, 37% said that they had educated themselves. This is another step in the right direction. It implies that a fair percentage of psychiatrists are 1) paying attention to their patients that present with dissociative symptoms; and 2) taking it seriously enough to educate themselves for the benefit of those patients.
It seems that the idea of multiple personalities is a distraction for many psychiatrists. Those who deny DID as a proper diagnostic entry in the DSM-5 often see it as good material for movies but not part of a patient profile that they would ever see or engage. For those psychiatrists, I would urge them to forget what they see as drama, and deal with the underlying trauma. Trauma is the issue. Perhaps we should consider changing the diagnostic, Dissociative Identity Disorder, to Complex PTSD with dissociation in the next DSM. Maybe something as simple as changing the name of the diagnosis would bypass the issue of psychiatrists being distracted and/or unwilling to acknowledge the dissociation that presents as alters or parts. With a name change like this, psychiatrists can treat the trauma and related dissociation in patients without having to worry about being seen by other psychiatrists as having committed a belief in the reality of alters before treating dissociative patients.
DID is basically a complex PTSD problem. When viewed through that lens, it is possible that psychiatrists, even those uncomfortable with the idea of DID, will be open to treating the trauma. And treating the trauma leads to healing. So maybe for those psychiatrists, it would be easier for them to treat DID if they see and identify it as Complex PTSD with dissociation! A label like that would not trigger the confusion that movies have caused in some psychiatrists, giving them license to see it is a scriptwriter’s (or patient’s) fantasy.
As an explanation for why so many in psychiatry continue to dismiss DID, the author of the study quotes Goethe: “You only see what you know.” Bluntly speaking, most DID patients present initially with depression – a known mental health issue with several readily available pharmaceutical treatment protocols. Because of this, many DID cases are missed. They are dismissed as depression and treated with pharmaceuticals. Remember the Goethe quote as to why this happens. The psychiatrists “know” depression; they do not know DID. Even better from their point of view, it is quick and easy to write a prescription.
One red flag that this mistaken approach raises is when the pharmaceutical treatment fails. Instead of acknowledging that the pharmaceutical treatment failure might indicate that the simplistic diagnosis of depression is incorrect, patients are given a different prescription medication. This can happen repeatedly, on and on, until the diagnosis is “refined” to be labeled “treatment resistant depression.”
Once the patient is diagnosed as having treatment resistant depression, the psychiatrist fails to examine the initial diagnostic assumption because this new diagnosis, as it says in the name, acknowledges the depression and identifies it as immovable. In short, such a psychiatrist has abdicated his responsibility to re-examine his diagnostic assumptions. With that abdication, etiology of DID – early childhood trauma – may never be identified. In that event, treatment will lack the key reference point of the need to address the early childhood trauma.
As I have noted before, this ignorance of DID generates a massive loss to individuals, families and society, in addition to major financial losses. Think of pain and suffering that continues for everyone whose lives are touched by DID as well as the money wasted on misdiagnosing a disorder that affects 1% to 1.5% of the population.
But let’s end on a positive note. The study indicates that 50% of the psychiatrists in the French study acknowledge DID, 37% of those have taken it upon themselves to learn about DID. These are beginning milestones that hopefully will spread to the psychiatrists in other countries.
