FastSaying

DID may be underdiagnosed. The image derived from classic textbooks of a florid, dramatic disorder with overt switching characterizes about 5% of the DID clinical population. The more typical presentation is of a covert disorder with dissociative symptoms embedded among affective, anxiety, pseudo-psychotic, dyscontrol, and self-destructive symptoms, and others (Loewenstein, 1991). The typical DID patient averages 6 to 12 years in the mental health system, receiving an average of 3 to 4 prior diagnoses. DID is often found in cases that were labeled as "treatment failures" because the patient did not respond to typical treatments for mood, anxiety, psychotic, somatoform, substance abuse, and eating disorders, among others. Rapid mood shifts (within minutes or hours), impulsivity, self-destructiveness, and/or apparent hallucinations lead to misdiagnosis of cyclic mood disorders (e.g., bipolar disorder) or psychotic disorders (e.g., schizophrenia).

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Interestingly, the patients who presented to me self-diagnosed [with Dissociative Identity Disorder had tried to tell previous therapists of their plight, but had been disbelieved. These therapists had used fallacious "capricious criteria" (KIuft, 1988) to discredit the diagnosis; e.g., that the patient could not possibly have MPD because she was aware of the other alters [sic!].
— Richard P. Kluft
capriciousdissociative-disorderdissociative-identity-disorder
Basic misunderstandings about DID encountered in the therapeutic community include the following:

° The expectation that all clients with DID will present in a Sybil-like manner, with obvious switching and extreme changes in personality.
° That therapists create DID in their clients.
° That DID clients have very little control over their internal systems and can be expected to stay in the mental health system indefinitely.
° That alter personalities, especially child alters, are simply regressive states associated with anxiety or that switching represents a psychotic episode.

Anyone who experiences dissociation on a regular basis knows better, however. DID is not only disruptive to everyday life but is also confusing and, at times, frightening.
— Deborah Bray Haddock
dissociativedissociative-identity-disorderdissociative-symptoms
as my understanding of and competence in treating the disorder have grown, multiple personality has come to seem, though still horrendous, less unique and incomprehensible, and thus more manageable
— Lynn I. Wilson
dissociative-disorderdissociative-identity-disorderhealing-from-abuse
Although Dissociative Disorders have been observed from the beginnings of psychiatry, the Structured Clinical Interview for DSM-III-R Dissociative Disorders (Steinberg 1985) was the first diagnostic instrument for the comprehensive evaluation of dissociative symptoms and to diagnose the presence of Dissociative Disorders.
— Marlene Steinberg
diagnosisdiagnostic-criteriadissociation
Early identification of patients who suffer from dissociative symptoms and disorders is essential for successful treatment, because these disorders do not resolve spontaneously. In addition, dissociative disorders are not alleviated by treatment directed toward an intercurrent disorder.
However, because the dissociative disorders are among the few psychiatric syndromes that appear to respond favorably to appropriate treatment (Spiegel, 1993), improved accuracy in differential diagnosis is critical.
— Marlene Steinberg
diagnosisdissociative-disordersdissociative-identity-disorder