Two or more personality systems are created from stressful precipitating events
Two or more personality systems are created from stressful precipitating events
Personalities are dramatically different
Needs inhibited in one personality are displayed in another
Alter identities represent fragments of a single person
Some alters may have more knowledge than others
Switches can be sudden or gradual
Often see depression, self-mutilation, suicide attempts and ideation, BPD, substance abuse, phobias
Gaps in memory are common
Usually starts in childhood, but not dx’d until 20s or 30s
3-9x more common in women—due to sexual abuse
Number of alters has increased over time—50% now show more than ten
identities; bizarre and unusual identities have also increased
Before 1979, only 200 cases had ever been reported. Post-Sybil and Three Faces of Eve, that has risen to 30-40,000 in North America
May have previously been dx’d as schizophrenia
Use of DID as a criminal defense is rare—Kenneth Bianchi—The Hillside Strangler
Use of DID as a criminal defense is rare—Kenneth Bianchi—The Hillside Strangler
Factitious and malingering cases are rare
Post-traumatic theory—over 95 % have memories of severe abuse. DID as a way to cope with overwhelming sense of hopelessness and powerlessness.
Escape—dissociation—occurs through a process like self-hypnosis/
Only some abused kids develop DID—diathesis stress model
Tend to be prone to fantasy, easily hypnotizable, intelligent
Sociocognitive theory—DID develops when a highly suggestible person learns to adopt and enact the roles of MPD due to therapist suggestions and reinforcement and because identities allow person to achieve personal goals—unintentional process.
Spanos and colleagues—normal college students could be induced by suggestion under hypnosis to show DID sx
This is consistent with those who have no sx of DID before therapy, but emerges in tx; also consistent with increase in dx as therapists became aware of dx
Tends to focus on integration
Tends to focus on integration
Psychodynamic and insight based
Few outcome studies. Many of those seem to be biased for positive results
Recovered memories—real or fake
Practitioners more likely to believe in recovered memories but
Memory is malleable and memories are subject to modification
Intense fear of gaining weight or becoming fat is coupled with a refusal to maintain minimal wt.
Intense fear of gaining weight or becoming fat is coupled with a refusal to maintain minimal wt.
At least 15 % wt loss without organic cause (usually 25-30%)
Active pursuit of thinness
Distorted body image
Amenorrhea
Two types: Restricting and Binge-eating/purging type—about 30-50% go from restricting to binge/purge
Restrictors are admired
Mortality: 3-21%--about 12x higher than other females age 15-24
Normal awareness of hunger, but terrified of giving in to impulse to eat.
Distorted perception of satiety.
Excessive activity.
90-95 % of cases are in females
90-95 % of cases are in females
Peak onset between 14-18
.5-2% prevalence in clinical populations. Higher rates of behaviors when we use an epidemiological approach.
Males tend to fall in a few specific groups—jockeys, wrestlers, models
So called Golden Girls disease.
Most common in industrialized nations (highest rates are here) but increasingly found everywhere.
Medical complications: Hair and nails thin and become brittle, dry skin, lanugo, yellowish tinge to skin, cold all the time, low bp, kidney damage, heart arrhythmias, electrolyte imbalances, osteoporosis
40% totally recover
40% totally recover
30% considerably improve
20% unimproved, seriously impaired
Remainder die
Early onset—more favorable prognosis
Poor prognosis—chronicity, pronounced family difficulties, poor vocational adjustment
Depression in 50-70%, appear to be separate disorders
Depression in 50-70%, appear to be separate disorders
OCD also fairly common
Some studies have found increased rates of sexual abuse, but these have generally all been methodologically flawed
1st classified as a disorder in 1980, therefore less research
1st classified as a disorder in 1980, therefore less research
Two types—purging and non-purging
Some argue that anorexia with binge/purge is just an underweight form of bulimia
Recurrent episodes of binge eating and repeated attempts to lose weight by severe dieting or purging (laxatives, vomiting, exercise)
Typical picture: white female begins overeating around 18 and purging a year later, generally vomiting
