0
Get Alert
Please Wait... Processing your request... Please Wait.
You must sign in to sign-up for alerts.

Please confirm that your email address is correct, so you can successfully receive this alert.

1
Letter to the Editor   |    
Treatment of Dissociative Identity Disorder
HAROLD MERSKEY, D.M.; AUGUST PIPER, JR., M.D.
Am J Psychiatry 1998;155:1462-1462.
View Author and Article Information
London, Ont., Canada

Letters to the Editor

To the Editor: The article by Joan Ellason, M.A., and Colin A. Ross, M.D. R4515510CEBBJCEG, is remarkable for a profusion of highly significant findings that are not scientifically meaningful.

In follow-up, those who have fared worst will be dead, unavailable, or uncooperative. Ellason and Ross obtained follow-up information on only 40% of their cohort. The high degree of selection in their study radically undermines their findings. We get no idea how many patients have deteriorated to suicide or died of self-neglect, have become incarcerated or hospitalized elsewhere, are homeless or cannot afford a telephone, or have suffered other causes of unavailability. Such patients would be unlikely to raise scores for improvement.

Ellason and Ross make no reference to the natural course of untreated dissociative identity disorder. Without this information, it is unjustified to imply that improvement resulted from the treatment. The Dissociative Disorders Interview Schedule lacks even face validity. It may be able to give replicable findings, but reliability does not prove validity. Patients who act a part may act it the same way twice, but a part in a charade is not a diagnostic entity. Likewise, Ellason and Ross rely on the Dissociative Experiences Scale, but Hacking R4515510CEBDGGJE concludes that scientists whose aim is to discover facts would be "thunderstruck" by the practices on which the scale is based.

Dissociative identity disorder is highly controversial (even on this continent), liable to be produced and maintained by suggestion, profoundly flawed in logic R4515510CEBEADEG, and promoted by social role expectations R4515510CEBDHJDF. A controversial diagnosis requires particularly well-drawn criteria for evaluation. However, the use of Kluft"s R4515510CEBDFDDE irredeemably nebulous "integration" criteria may trap the unwary. For example, Ellason and Ross accept "the absence of behaviorally evident separate identities." Yet Kluft has claimed that at the time of diagnosis, 40% of dissociative identity disorder patients may show no overt signs of the disorder R4515510CEBDFDDE. Perhaps Ellason and Ross excluded such cases from their cohort, but Ross himself R4515510CEBCBIDC further complicates the matter. He warns that alter personalities may enter "inner hibernation," sometimes for lengthy periods in which state they do not manifest themselves to the outside observer. One wonders how the present authors determined that their subjects" improvements were not examples of this phenomenon.

Ellason JW, Ross CA: Two-year follow-up of inpatients with dissociative identity disorder. Am J Psychiatry  1997; 154:832–839
[PubMed]
 
Hacking I: Rewriting the Soul: Multiple Personality and the Science of Memory. Princeton, NJ, Princeton University Press, 1995, p 112
 
Piper A Jr: Hoax and Reality: The Bizarre World of Multiple Personality Disorder. Northvale, NJ, Jason Aronson, 1997
 
Spanos NP: Multiple Identities of False Memories: A Socio-Cognitive Perspective. Washington, DC, American Psychological Association, 1996
 
Kluft RP: An introduction to multiple personality disorder. Psychiatr Annals  1984; 14:19–24
 
Ross CA: Multiple Personality Disorder: Diagnosis, Clinical Features and Treatment. New York, John Wiley & Sons, 1989
 
+

References

Ellason JW, Ross CA: Two-year follow-up of inpatients with dissociative identity disorder. Am J Psychiatry  1997; 154:832–839
[PubMed]
 
Hacking I: Rewriting the Soul: Multiple Personality and the Science of Memory. Princeton, NJ, Princeton University Press, 1995, p 112
 
Piper A Jr: Hoax and Reality: The Bizarre World of Multiple Personality Disorder. Northvale, NJ, Jason Aronson, 1997
 
Spanos NP: Multiple Identities of False Memories: A Socio-Cognitive Perspective. Washington, DC, American Psychological Association, 1996
 
Kluft RP: An introduction to multiple personality disorder. Psychiatr Annals  1984; 14:19–24
 
Ross CA: Multiple Personality Disorder: Diagnosis, Clinical Features and Treatment. New York, John Wiley & Sons, 1989
 
+
+

CME Activity

There is currently no quiz available for this resource. Please click here to go to the CME page to find another.
Submit a Comments
Please read the other comments before you post yours. Contributors must reveal any conflict of interest.
Comments are moderated and will appear on the site at the discertion of APA editorial staff.

* = Required Field
(if multiple authors, separate names by comma)
Example: John Doe



Related Content
Books
The American Psychiatric Publishing Textbook of Psychiatry, 5th Edition > Chapter 15.  >
Gabbard's Treatments of Psychiatric Disorders, 4th Edition > Chapter 34.  >
Gabbard's Treatments of Psychiatric Disorders, 4th Edition > Chapter 34.  >
Topic Collections
Psychiatric News
PubMed Articles
The psychiatric sequelae of burn injury. Gen Hosp Psychiatry Published online May 17, 2014.;
The diagnosis and treatment of pediatric narcolepsy. Curr Neurol Neurosci Rep 2014;14(8):469.