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Friday, April 21, 2006
Tuesday, April 11, 2006
Defining the controversy
Defining the controversy
One of the primary reasons for the on-going re-categorization of this condition is that there were so few documented cases (research in 1944 showed only 76[1]) of what was then referred to as multiple personality. Although the condition does have a long history stretching back in the literature some 300 years, it remains a rare disorder, affecting less than 1% of the population (Ross, 1997). Conversely, dissociation is now recognized as a symptomatic presentation in response to trauma, extreme emotional stress, and, as noted, in association with emotional dysregulation and borderline personality disorder[2]. Often regarded as a dynamic sub-symptomology, it has become more frequent as an ancillary diagnosis, rather than a primary diagnosis. [citation needed] A full blown DID diagnosis, that intends an individual is evidencing quantifiable multiple personalities and presents itself independently of a primary personality disorder, remains rare. [citation needed]
The DSM re-dressThere is considerable controversy over the validity of the Multiple personality profile as a diagnosis. Unlike the more empirically verifiable mood and personality disorders, dissociation is primarily subjective for both the patient, and the treatment provider. The relationship between dissociation and multiple personality creates conflict regarding the MPD diagnosis. While other disorders do, indeed, require a certain amount of subjective interpretation, those disorders more readily present with generally accepted, objective symptomology. The controversial nature of the dissociation hypothesis evidences itself quite clearly by the manner in which the American Psychiatric Association's Diagnostic and Statistical Manual of Mental Disorders has addressed, and re-dressed, the categorization over the years.
The 2nd Edition of the Diagnostic and Statistical Manual of Mental Disorders, referred to this diagnostic profile as Multiple Personality Disorder. The 3rd Edition of the DSM Manual grouped Multiple Personality Disorder in with the other 4 major dissociative disorders. The current edition, the DSM-IV-TR, categorizes the disorder as Dissociative Identity Disorder. The ICD-10 (International Statistical Classification of Diseases and Related Health Problems) continues to list the condition as multiple personality disorder.
One of the primary reasons for the on-going re-categorization of this condition is that there were so few documented cases (research in 1944 showed only 76[1]) of what was then referred to as multiple personality. Although the condition does have a long history stretching back in the literature some 300 years, it remains a rare disorder, affecting less than 1% of the population (Ross, 1997). Conversely, dissociation is now recognized as a symptomatic presentation in response to trauma, extreme emotional stress, and, as noted, in association with emotional dysregulation and borderline personality disorder[2]. Often regarded as a dynamic sub-symptomology, it has become more frequent as an ancillary diagnosis, rather than a primary diagnosis. [citation needed] A full blown DID diagnosis, that intends an individual is evidencing quantifiable multiple personalities and presents itself independently of a primary personality disorder, remains rare. [citation needed]
The DSM re-dressThere is considerable controversy over the validity of the Multiple personality profile as a diagnosis. Unlike the more empirically verifiable mood and personality disorders, dissociation is primarily subjective for both the patient, and the treatment provider. The relationship between dissociation and multiple personality creates conflict regarding the MPD diagnosis. While other disorders do, indeed, require a certain amount of subjective interpretation, those disorders more readily present with generally accepted, objective symptomology. The controversial nature of the dissociation hypothesis evidences itself quite clearly by the manner in which the American Psychiatric Association's Diagnostic and Statistical Manual of Mental Disorders has addressed, and re-dressed, the categorization over the years.
The 2nd Edition of the Diagnostic and Statistical Manual of Mental Disorders, referred to this diagnostic profile as Multiple Personality Disorder. The 3rd Edition of the DSM Manual grouped Multiple Personality Disorder in with the other 4 major dissociative disorders. The current edition, the DSM-IV-TR, categorizes the disorder as Dissociative Identity Disorder. The ICD-10 (International Statistical Classification of Diseases and Related Health Problems) continues to list the condition as multiple personality disorder.
DSM-IV-TR diagnostic criteria
DSM-IV-TR diagnostic criteria
Due to copyright infringement issues and editorial concerns, the American Psychiatric Association has requested that specific reference to the DSM-IV-TR by Wikipedia be outlinked. The current diagnostic criteria for Dissociative identity disorder published in the Diagnostic and Statistical Manual of Mental Disorders may be found here:
A definition of dissociationDissociation is a complex mental process that provides a coping mechanism for individuals confronting painful and/or traumatic situations. It is characterized by a dis-integration of the ego. Ego integration, or more properly ego integrity, can be defined as a person's ability to successfully incorporate external events or social experiences into their perception, and to then present themselves consistently across those events or social situations. A person unable to do this successfully can experience emotional dysregulation, as well as a potential collapse of ego integrity. In other words, this state of emotional dysregulation is, in some cases, so intense that it can precipitate ego dis-integration, or what, in extreme cases, has come to be referred to diagnostically as dissociation.
Dissociation describes a collapse in ego integrity so profound that the personality is considered to literally break apart. For this reason, dissocation is often referred to as "splitting" or "altering". Less profound presentations of this condition are often referred to clinically as disorganization or decompensation. The difference between a psychotic break and a dissociation, or dissociative break, is that, while someone who is experiencing a dissociation is technically pulling away from a situation that s/he cannot manage, some part of the person remains connected to reality. While the psychotic "breaks" from reality, the dissociative disconnects, but not all the way.
Because the person suffering a dissociation does not completely disengage from his/her reality, s/he may appear to have multiple "personalities". In other words, different "people" (read: personalities) to deal with different situations, but generally speaking, no one person (read: personality) who will retreat altogether.
Due to copyright infringement issues and editorial concerns, the American Psychiatric Association has requested that specific reference to the DSM-IV-TR by Wikipedia be outlinked. The current diagnostic criteria for Dissociative identity disorder published in the Diagnostic and Statistical Manual of Mental Disorders may be found here:
A definition of dissociationDissociation is a complex mental process that provides a coping mechanism for individuals confronting painful and/or traumatic situations. It is characterized by a dis-integration of the ego. Ego integration, or more properly ego integrity, can be defined as a person's ability to successfully incorporate external events or social experiences into their perception, and to then present themselves consistently across those events or social situations. A person unable to do this successfully can experience emotional dysregulation, as well as a potential collapse of ego integrity. In other words, this state of emotional dysregulation is, in some cases, so intense that it can precipitate ego dis-integration, or what, in extreme cases, has come to be referred to diagnostically as dissociation.
Dissociation describes a collapse in ego integrity so profound that the personality is considered to literally break apart. For this reason, dissocation is often referred to as "splitting" or "altering". Less profound presentations of this condition are often referred to clinically as disorganization or decompensation. The difference between a psychotic break and a dissociation, or dissociative break, is that, while someone who is experiencing a dissociation is technically pulling away from a situation that s/he cannot manage, some part of the person remains connected to reality. While the psychotic "breaks" from reality, the dissociative disconnects, but not all the way.
Because the person suffering a dissociation does not completely disengage from his/her reality, s/he may appear to have multiple "personalities". In other words, different "people" (read: personalities) to deal with different situations, but generally speaking, no one person (read: personality) who will retreat altogether.
Dissociative identity disorder
Dissociative identity disorder
Dissociative identity disorder is a diagnosis described in the Diagnostic and Statistical Manual of Mental Disorders, 4th Edition, Revised, as the existence in an individual of two or more distinct identities or personalities, each with its own pattern of perceiving and interacting with the environment. At least two of these personalities are considered to routinely take control of the individual's behavior, and there is also some associated memory loss, which is beyond normal forgetfulness. This memory loss is often referred to as "losing time". These symptoms must occur independently of substance abuse, or a general medical condition.
Dissociative identity disorder was initially named multiple personality disorder, and, as referenced above, that name remains in the International Statistical Classification of Diseases and Related Health Problems. Regardless of whether the disorder is termed dissociative identity disorder or multiple personality disorder, it is in no way related to schizophrenia. Although schizophrenia and dissociative identity disorder are commonly linked in the minds of lay people, it is a misconception.
While dissociation is a demonstrable psychiatric condition that is tied to several different disorders, specifically those involving early childhood trauma and anxiety, multiple personality remains controversial. Despite the controversy, many mental health institutes such as McLean Hospital, perhaps the best mental health institute in the world, have wards specifically designated for dissociative identity disorder.
Dissociative identity disorder is a diagnosis described in the Diagnostic and Statistical Manual of Mental Disorders, 4th Edition, Revised, as the existence in an individual of two or more distinct identities or personalities, each with its own pattern of perceiving and interacting with the environment. At least two of these personalities are considered to routinely take control of the individual's behavior, and there is also some associated memory loss, which is beyond normal forgetfulness. This memory loss is often referred to as "losing time". These symptoms must occur independently of substance abuse, or a general medical condition.
Dissociative identity disorder was initially named multiple personality disorder, and, as referenced above, that name remains in the International Statistical Classification of Diseases and Related Health Problems. Regardless of whether the disorder is termed dissociative identity disorder or multiple personality disorder, it is in no way related to schizophrenia. Although schizophrenia and dissociative identity disorder are commonly linked in the minds of lay people, it is a misconception.
While dissociation is a demonstrable psychiatric condition that is tied to several different disorders, specifically those involving early childhood trauma and anxiety, multiple personality remains controversial. Despite the controversy, many mental health institutes such as McLean Hospital, perhaps the best mental health institute in the world, have wards specifically designated for dissociative identity disorder.
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