LETTERS TO THE EDITOR The Journal of Nervous and Mental Disease & Volume 201, Number 4, April 2013 http://www.jonmd.com p. 353 – 358
Growing Not Dwindling: Worldwide Phenomenon of Dissociative Disorders
To the Editor:
In the December 2012 issue of the Journal, Joel Paris, MD, wrote an article about the current status of dissociative identity disorder (DID) and the dissociative disorder field in general. He suggests that DID is merely a ‘‘fad’’ and that there is no credible evidence to connect traumatic experiences with the development of DID. We refute several of the claims made by Dr Paris.
Our biggest concern as non-North American researchers is that Dr Paris does not reference a single international study related to dissociative disorders and DID, despite the considerable and increasing empirical literature from around the world. His speculation that DID is not diagnosed outside clinics that specialize in treating dissociation is not consistent with current data. DID and dissociative disorders have been reliably found in general psychiatric hospitals; psychiatric emergency departments; and private practices in countries including England, the Netherlands, Turkey, Puerto Rico, Northern Ireland, Germany, Finland, China, and Australia, among many others….
Much of the international research, using sophisticated epidemiological and clinical research methods, has replicated dozens of times the finding that dissociative processes and disorders (including DID) can be reliably detected in a wide spectrum of different societies. Epidemiological general population studies indicate that 1.1% to 1.5% meet diagnostic criteria for DID; and 8.6% to 18.3%, for any DSM-IV dissociative disorder (Johnson et al., 2006; Sar et al., 2007a). The international literature on DID and dissociative disorders has been widely published in mainstream journals of psychiatry and psychopathology and is inconsistent with Dr Paris’s conclusions….
Dr Paris also opines that there is only a ‘‘weak link’’ between child abuse and psychopathology, quoting an article published 17 years ago. Current research illustrates a very different picture. Persons with early abusive experiences demonstrate increased illnesses (Green and Kimerling, 2004), impaired work functioning (Lee and Tolman, 2006), serious interpersonal difficulties (Van der Kolk and d’Andrea, 2010), and a high risk for traumatic revictimization (Rich et al., 2004). The Adverse Childhood Experiences Study, an American epidemiological study, has provided retrospective and prospective data from more than 17,000 individuals on the effects of traumatic experiences during the first 18 years of life.
In conclusion, Dr Paris’s assessment of the supposedly dwindling fad of DID and dissociative disorders is not in keeping with current peer-reviewed international research. The dissociative disorder field has been producing solid and consistent evidence that provides guidance to clinicians and researchers about the epidemiology, phenomenology, diagnosis, and treatment of DID (and closely related conditions).
Alfonso Marti´nez-Taboas, PhD Department of Psychology
Carlos Albizu University San Juan, Puerto Rico
Martin Dorahy, PhD Department of Psychology University of Canterbury
Christchurch, New Zealand
Vedat Sar, MD Department of Psychiatry Istanbul University Istanbul, Turkey
Warwick Middleton, MD Department of Psychiatry University of Queensland
St Lucia, Australia
Christa Kru¨ger, MD Department of Psychiatry University of Pretoria
Pretoria, South Africa
Journal of Nervous & Mental Disease: April 2013 – Volume 201 – Issue 4 – p 353–354 doi: 10.1097/NMD.0b013e318288d27f
Letters to the Editor
Disinformation About Dissociation Dr Joel Paris’s Notions About Dissociative Identity Disorder
To the Editor:
We write to record our objections to both the form and the content of Dr Joel Paris’s recent article entitled The Rise and Fall of Dissociative Identity Disorder (Paris, 2012). His claim that dissociative identity disorder (DID) is a ‘‘medical fad’’ is simply wrong, and he provides no substantive evidence to support his claim. From the mistaken identification of Pierre Janet as a psychiatrist in the first line (Janet was the most famous psychologist of his day), it is replete with errors, false claims, and lack of scholarship and just plainly ignores the published literature. Dr Paris provided a highly biased article that is based on opinion rather than on science. His review of the literature is extremely selective. Of 48 references, Dr Paris cites exactly 7 peer-reviewed articles published from 2000 onward (7/48 references equals 14%) and only 8 peer-reviewed, data-driven articles from before 2000 (8/48 equals 16%). Rather than relying on the recent peer-reviewed, scientific literature, Paris relied almost entirely on the non-peer-reviewed books, including a popular press book written by a journalist whose methods and conclusions have been strongly challenged.
He claims that interest and research in DID have waned, yet he fails to cite the multitude of studies that have been conducted about it. In fact, Dalenberg et al. (2007) documented evidence of the exact opposite pattern described by Paris: ‘‘A search of the PILOTS database offered by the National Center for Posttraumatic Stress Disorder for articles on dissociation reveals 64 studies in 1985-1989, 236 published in 1990-1994, 426 published in 1995-1999 and 477 in the last 5-year block (2000-2004)’’ (p. 401)….
In addition, he fails to cite a variety of neurobiological and psychophysiological studies of DID documenting similar brain morphology abnormalities in patients with DID to those of other traumatized patients (Reinders et al., 2006; Vermetten et al., 2006). Despite failing to review this and other relevant research, Dr Paris made the claim that ‘‘Neither the theory behind the diagnosis nor the methods of treatment are consistent with the current preference for biological theories’’ (p. 1078). Furthermore, he fails to cite any research that has been done by researchers outside North America. For example, Vedat Sar, MD, in Turkey has published more than 70 articles and chapters on dissociative disorders and trauma (http://vedatsar.com/ index_2.htm), but Dr Paris failed to mention a single one….
A recent review in Psychological Bulletin by 2012) found strong support for the etiological relationship of trauma and dissociation. These included several large meta-analyses, some of which focused on patients with DID. Dalenberg et al. (2012) found an effect size of r = 0.52 and 0.54 for the relationship between childhood physical abuse and sexual abuse, respectively, in studies that compared individuals with dissociative disorders with those without dissociative disorders. In addition, Dalenberg et al. (2012) tested eight different predictions of the trauma versus the fantasy (sociocognitive/iatrogenic) model of dissociation. On each, careful of reviews of the literature, including meta-analyses, on memory, suggestibility, and neurobiology, among others, Dalenberg et al. (2012) found minimal scientific evidence to support the fantasy model. Further, reviews have shown that there are no research studies in the literature in any population studied to support the iatrogenic/sociocognitive etiology of DID promulgated by Dr Paris (Brown et al., 1999; Loewenstein, 2007)….
Dr Paris’s article does not provide scholarly criticism based upon peer reviewed research, scientific data, or accurate discussion of the history of psychiatry. His point of view is incorrect and outmoded. It is the so-called false-memory, iatrogenesis model of the dissociative disorders that is the fallen fad, buried under the weight of rigorous data that contradict it. Dissociative disorders have not risen and fallen. These existed before the fields of psychiatry and psychology did….
Bethany Brand, PhD Department of Psychology Towson University, MD
Richard J. Loewenstein, MD The Trauma Disorders Program Sheppard Pratt Health System Baltimore, MD Department of Psychiatry University of Maryland School of Medicine Baltimore
David Spiegel, MD Department of Psychiatry and Behavioral Sciences
Stanford University School of Medicine CA
Journal of Nervous & Mental Disease: April 2013 – Volume 201 – Issue 4 – p 354–356 doi: 10.1097/NMD.0b013e318288d2ee Letters to the Editor