For Encéphale Congress In 2023, a session was dedicated to Dissociative Identity Disorder (DID). This is a condition that exerts some fascination and has been depicted in countless movies and television shows. While it may be the key to success at the box office and ratings, DID remains a controversial issue within the mental health community.In fact, a survey of 800 French psychiatrists found that 51 % either have doubts about the existence of the disease – which is becoming increasingly common among adolescents, at least on the Internet – or do not believe in the existence of DID at all. So psychiatry or fantasy? This is the question posed in the title of the meeting. Whichever area this phenomenon of multiple identities falls into, it is clear that DID is part of the broader phenomenon of «plurals culture» that has been observed among young people in recent years.
The DID, formerly known as multiple personality disorder, is listed in the fifth edition of Diagnostic and Statistical Manual of Mental Disorders (DSM-5). DID is characterized by the presence of more than two personalities within a single person.This leads to situations where the person «switches» between their different identities (also called self-states or parts).
People with DID often experience episodes of amnesia in terms of traumatic events experienced as well as elements of daily life. A video played at the beginning of the session showed Dr. Coraline Hingray, a psychiatrist at the University Hospital of Nancy, in an interview with a young woman named Maïlé Onfray. In 2017, Onfray, who grew up in a cult, was diagnosed with DID and post-traumatic stress disorder. She defined her dissociative parts as completely separate from each other, with each having his own world and experiences. However, she did not want to list or list them all because «that would mean separating them even more, although she hopes to be able to reunite them».
Although she claimed to constantly switch between these identities during the day, she said that these changes -for example, her voice or her language – were «something subtle and not a show.»Onfray mentioned episodes in which she doesn’t have her usual skills and abilities – teaching children, using a computer – and then regaining them without remembering what she had done at that moment. A DID is very often associated with overwhelming childhood trauma – as in the case of Onfray, with psychological, physical and sexual violence within the cult. For the DID patient, this leads to «a lot of suffering and loneliness».
From Alfred Hitchcock’s Psycho to M. Night Shyamalan’s Split — Hollywood has long been fascinated by the DID. In recent years, such disorders have been frequently reported by young adults on social media. But the scientific community is still not convinced.
The results of several studies clearly indicate that this disease has concrete characteristics.They also suggest that up to 1—% of the general population could be affected. Psychiatrists, however, question the existence of DID, and view the phenomenon as a fad that has increased so much in recent years that one wonders if it is an «epidemic» in child and adolescent psychiatry.
What about French psychiatrists? Which side do they belong to? Are they on the side of the skeptics or the convinced? To find out, Hingray interviewed 800 of them. Their answers will be published in the journal Encéphale. In the meantime, here are the key findings.
For starters, Hingray said, French psychiatrists categorized DID among the patients they treated as a «rare diagnosis.» In fact, two-thirds of doctors said they had never treated a DID patient.24 % of those who have seen DID patients said they had treated between one and four of these patients. Almost half of the respondents (48 %) stated that the patients they had treated during the year had made this diagnosis themselves.
Do psychiatrists believe that by and large they have been trained for dissociative disorders? The answer of 61 % of psychiatrists was «no». Of those who answered this question in the affirmative, 37-_% stated that they had taken steps to educate themselves, e.g. by attending congresses or reading specialist literature on the subject.
When asked about the epidemiology of this disease, most psychiatrists (67 %) estimated the prevalence at 0.15 %. For example, 32 % stated that in their opinion 1.5 % of the population had a DID.According to an article from the year 2018by Richard J. Loewenstein, the actual prevalence is between 1 % and 1.5 %.
The survey asked psychiatrists about their knowledge of DID. The majority were familiar with the DSM-5 definition and were aware that trauma was the underlying etiology. In addition, they knew that psychotherapy was the recommended first-line treatment.
While most doctors say they care about the disease, it gets a little more complicated when asked if they think the condition exists. «Here the opinions are fairly evenly divided, 50:50. That is, 51 % doubt very strongly that the __-DID exists, or simply do not believe that it exists,» Hingray explained.
So is it something created by the media?Once again, the opinion of psychiatrists is divided. «They continue to maintain that this condition occurred as a result of what people see in movies like Split, in the mass media and on TikTok. Nevertheless, the fact that an overwhelming majority of 80% of respondents consider that patients do not fake or pretend to do so is a clear confirmation of the existence of the disease.»
Can this condition be confused with another? Absolute. While psychiatrists disagree about the similarity of DID to schizophrenia, they are more certain about the similarity of DID with borderline personality disorder (BPD).
Hingray concluded by saying that she believed that, as Goethe put it, «you only see what you know.» She acknowledged that the chameleon effect is involved in the DID.This is because dissociation is a protective mechanism: it enables the person to behave in an avoidance manner. In addition, it can take all possible forms (e.g. panic disorder, obsessive-compulsive disorder, treatment-resistant depression, atypical schizophrenia).
With this in mind, Hingray urged her colleagues to pay attention to atypical psychiatric symptoms. And since she herself believes that the DID is real, she encouraged her colleagues to deal with the disorder, to inform themselves about it. The more they know about DID, the better they can recognize the symptoms and treat them accordingly.
The plural culture
Dr. Julie Rolling is a child psychiatrist at the University Hospitals of Strasbourg. In her congress presentation: «DID: an epidemic in child and adolescent psychiatry», she gave an overview of the literature on the phenomenon of the existence of multiple identities. Delving deeper into the subject, she delved into teenagers’ attitudes towards DID and, more broadly, the phenomenon of multiple personality.In recent years, this culture has grown, and the phenomenon mentioned has put teenagers in particular into a «frenzy».
«Plurals» is the English non-medical term used to describe people who have the characteristic feature of having several «personalities» without having one DID. «These individuals are more likely to make their own diagnosis. They have a very detailed inner world, and the relationships between the ‘parts’ are something that plurals find reassuring»,explained Rolling. She wondered if it could be that teenagers, precisely because they are teenagers, are particularly susceptible to this «plurals» phenomenon. In fact, this phenomenon seems to be a new globalized online culture whose philosophy of life is «the plurality of identities as normal psychological preference» and which is associated with its own language (e.g.»functional diversity» and «non-human identities»), a social group (mainly in social media) and, for some, a political dimension encompassing activism.
Teenagers might be attracted to the «desire for originality» associated with this new culture. «This concept of dissociative ‘parts’ would provide [them] with an explanation for the identity confusion, emotional conflicts, and interpersonal difficulties they may be experiencing. All these things would make sense [to them],» she suggested. «A DID diagnosis could then bring structure to the inner chaos.»
Rolling suggests that DID could also appeal to the kind of teenagers who could use the mutual help on social media and the interest it generates. Or even for the kind of teenagers who would gain a new status as DID patients that makes them experts in DID.»There are so many important issues—being recognized as identity, narcissistic self-expression—that can represent responses to the psychological changes in adolescence,» she explains.
Finally, Rolling mentioned the similarity of this condition to a new diagnosis: Reality shift (reality shifting, RS), a newly emerging online daydreaming culture that took hold during the COVID pandemic. RS is «the experience of being able to overcome one’s physical limits and visit alternative, mostly fictional universes.» Rolling concluded by noting that the DID – a complex disease – raises many questions. In particular, «the relevance of diagnosis at an important stage of development». However, she added, more generally, «This raises the question of what impact online communities and social media have on diagnosing younger patients.»
This article was translated from the French edition of Medscape.
It was originally published on medscape.com
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