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The Status of DID

FMSF News Alert - June 6, 2014

Dear Friends,

Status of DID Part 1: Boysen & VanBergen (2013) Paper

Is dissociative identity disorder (DID) an accepted and well-researched subject in the field of psychopathology?

Is dissociative identity disorder (DID) an accepted and well-researched subject in the field of psychopathology? Is DID a consequence of childhood sexual abuse or is it a culture-bound phenomenon brought about by treatment?

Fierce debate on these questions has been going on for decades. What is particularly confusing to non-scientists is that the two sides look at the same studies and come to opposite conclusions. Indeed, it was just that problem that led Harvard psychologist Richard McNally over a decade ago to write Remembering Trauma, a book that explains in compelling detail why the scientific evidence for DID fails to support childhood sexual abuse as a cause.

In 2006, Harrison Pope and colleagues examined the issue in another way: they tracked the publication rates of research about DID from 1984 to 2003. Their analysis showed that publications about DID peaked in the late 1990s and were followed by a steep fall in the number of research studies. The authors compared this pattern with research publications in other areas such as alcohol abuse or anorexia or schizophrenia, all of which all showed steady increases in research. They argued that DID was a fad.

Proponents of DID countered that Pope’s research missed some studies supporting the scientific nature of DID. On one point, all agree: it is the content of the DID studies that is important, not the number of studies. Unfortunately, a detailed analysis of all those studies was never completed.

Researchers Guy Boysen and Alexandra Van Bergen write that: "a detailed and thorough analysis of the content of the DID literature...may be the only way to establish the current status of DID in the scientific literature." To do this they searched MEDLINE and PsychINFO and included articles published in English, about adults, and in peer-reviewed journals between 2000 and 2010. What they found:

Research Output

21 case studies and 80 empirical articles with aggregated cases

1,171 new cases of DID emerged in all the publications above

Research Trends

Mean number of articles is 9 per year

Fewer case studies with time

Research Topics

Only 3 of the case studies looked at etiology

54 percent of empirical studies were descriptive rather than explanatory

15 of the empirical studies looked at etiology with post traumatic stress the most common approach.

Prevalence Across Cultures

82 percent of newly identified cases of DID came from Western countries

Turkey accounted for 79 percent of all non-Western cases

Diagnostic Methods

In case studies, nine specified method of diagnosis. DSM criteria most common

In empirical studied structured interviews were most common

Five research groups accounted for 67 percent of all new DID cases

Simulation of DID

13 studies compared people diagnosed with DID with those simulating DID; 9 found no difference

The authors note that most of the research is descriptive and did not try to explain the cause of DID. They write that there are have been about 10 articles and 100 new cases of DID emerging in the literature each year. Most cases were identified by a small number of countries and clinicians. People simulating DID were mostly indistinguishable from people diagnosed with DID and "Not a single unassailable case of DID occurring independently from treatment emerged from the review."

The authors conclude that "Overall, DID is still a topic of study, but the research lacks the productivity and focus needed to resolve ongoing controversies surrounding the disorder."

In other words, dissociative identity disorder is neither generally accepted in the scientific community nor has it been well researched by its proponents.

Boysen, G.A. & Van Bergen, A (2013, January). A Review of Published Research on Adult Dissociative identity Disorder 2000-2010. Journal of Nervous and Mental Disease, Vol. 301, No 1, 5 - 11.

If you would like a copy of this paper, email FMSF at mail@fmsfonline.org. Please put "DID paper request" in the subject heading.

* * * * * * * * * *

Status of DID part 2 - Dixson v Beattie Case

Maryland Trial Court Allows Testimony About Repressed-Memory

Dixson v. Beattie, Case No. 375001-V Montgomery, Maryland County Circuit Court, May 7, 2014

The Maryland Court of Appeals (the state’s highest court) noted, in Doe v. Maskell that "[T]he studies purporting to validate repression theory are justly criticized as unscientific, unrepresentative and biased." The Court determined, based on expert testimony presented at a lengthy evidentiary hearing before the trial court, that science had not progressed to the point that "repression" could be distinguished from simple "forgetting," and that the two should therefore be treated the same under the law, i.e., neither should activate the discovery rule. Doe v. Maskell, 679 A.2d 1087 (Md. 1996), cert. denied, 117S. Ct. 770 (1997)

Case:

Three sisters filed a suit in Maryland against James Beattie for sexually abusing them when he was dating their mother in the mid 1970s. The defendant sought to have the case dismissed because the statute of limitations had passed. The sisters asked the court not to follow Doe v. Maskell and to allow the jury to hear evidence about dissociative amnesia to explain their delay in filing. The sisters asked to have Doe v Maskell reexamined in light of existing scientific knowledge. They contend that since 1996, the theory of dissociative amnesia has become generally accepted in the relevant scientific community.

The court held a Frye-Reed Hearing on March 27, 2014. The plaintiffs’ expert witness was Joyanna Lee Silberg, Ph.D. Since 1997, she has been the head of the Childhood Trauma Unit of the Sheppard Pratt Health System. Dr. Silberg testified that dissociative amnesia is generally accepted in the scientific community. She testified that "the condition has been repeatedly observed clinically and recognized scientifically in peer-reviewed journal articles and studies."

The defendant’s expert witness was Harrison Pope, M.D., professor of psychiatry at Harvard Medical School and Director of the Biological Psychiatry Laboratory and McLean Hospital. Dr. Pope disagreed "that a patient could completely forget a traumatic event but recall it at some later date." He testified that "dissociative disorder" or "repressed memory" is not generally accepted in the scientific community."

At the conclusion of the hearing, Judge Ronald B. Rubin [1] issued a statement saying that "dissociative amnesia has been sufficiently tested by the psychiatric and psychological community using research methods generally applied in those fields and that it is generally accepted."

Attorney for the Plaintiffs was Steven A. Vangrack of Steven Vangrack Law, P.C., Rockville, Maryland.

Attorneys for the Defendant were Levi S. Zaslow and Timothy Maloney of Joseph, Greenwald and Laake, P.A., Greenbelt, MD

Judge Dolan’s opinion can be found here: Dixson Frye-Reed Decision

The trial is scheduled to begin on June 9, 2014.

* * * * * * * * * *

Comments:

It is disturbing to see any chipping away of the gains that were made in the past two decades to prevent "junk" science about memory from the courtroom. But it can be constructive to examine some of the reasoning.

Judge Rubin was especially dismissive of Harrison Pope’s peer-reviewed 1999 study of psychiatrists stating: "Dr. Pope’s after-the-fact "survey" of a small number of psychiatrists who are dissatisfied with the work of the DSM committees, is not persuasive evidence of anything other than that some doctors disagree." The judge also wrote "Although there are some 36,000 physician members of the APA, Dr. Pope sent a questionnaire to 406 individuals." These seem naive comments given the ubiquitous use of statistical sampling.

It is unfortunate that Judge Rubin did not read the Boysen & VanBergen paper described in the first part of this news alert that addressed the issue of whether dissociative identity disorder was an accepted and well-researched subject in psychopathology. Those authors concluded: "Overall, DID is still a topic of study, but the research lacks the productivity and focus needed to resolve ongoing controversies surrounding the disorder." Indeed, DID continues to be embroiled in ongoing controversies and as such cannot be said to have been accepted by the relevant scientific community.

Rubin’s decision stated: "The court finds that the DSM-5 ‘is the handbook used by health care professionals in the United States and much of the world as the authoritative guide to the diagnosis of mental disorders.’ It is the ‘gold standard’ by which mental health professionals diagnose patients and, ultimately, bill private and public health insurers for treatment. The court finds that its mental health criteria, including dissociative amnesia, are generally accepted in the relevant scientific community."

Although Dr. Pope’s testimony explained why the DSM should not be the basis for determining the scientific status of DID, Judge Rubin was not persuaded. We urge readers to read "But It’s in the DSM" on the FMSF website.

And also to consider the following comments from S. Robbins, Ph.D.

"Given the dual processes of consensus and authority that are used to create the categories and specific diagnoses that are included and excluded, it is crucial to recognize that the DSM is, first and foremost, a socially constructed document. Rather than being based on demonstrable advances toward a scientific understanding of mental distress, it reflects not only the views and interests of the members appointed to the DSM task force, but also the interests of those that provide funding for and benefit from its creation and widespread use."

"Not surprisingly, the changes in DSM-5 engendered considerable controversy, and scathing critiques of the clandestine process and proposed revisions appeared in professional journals, in online blogs, as well as in the mainstream media. Significant concerns were raised about clear financial ties to pharmaceutical companies; the dramatic rise in the use of psychiatric medications, particularly (but not exclusively) in young children; the neglect of social and environmental factors; the increasing medicalization of normal or distressing life experiences; the expansion of psychiatric diagnoses into multiple aspects of life; the stigma of labeling; biological reductionism; the consolidation of some diagnoses and the addition or elimination of others; the lowered threshold required for diagnosis; and the fact that it is unlikely to improve treatment; among other issues (see, for example, Cosgrove, 2010; Francis, 2013; Francis & Jones, 2014; Gambrill, 2013; Smullins, 2013; Wakefield, 2013)."

Robbins, S. (2014). From the Editor - The DSM-5 and Its Role in Social Work Assessment and Research. Journal of social Work Education, Vol. 50, Issue 2, 201-205. Download for free at: www.tandfonline.com/eprint

Pope, Jr., H.G. et al., (1999). Attitudes Toward DSM-IV Dissociative Disorder Diagnosis Among Board-Certified American Psychiatrists. American Journal of Psychiatry, 156, 321-323.

1. Judge Rubin presented a paper on "Expert Testimony Under Frye-Reed: Trends and Recent Cases" at the Maryland State Bar Association, March 10, 2011.

For Further reading on the controversies surrounding the DSM see also:

Frances, A. (2013). Saving Normal: An insider’s Revolt Against Out-of-Control Psychiatric Diagnosis, DSM-5, Big Pharma, and the Medicalization of Ordinary Life. William Morrow Publishing

Greenburg, G. (2013). The Book of Woe: The DSM and the Unmaking of Psychiatry. Blue Rider Press

Pam and J. Bean