Who will you be this Halloween?

For children and adults alike, the most exciting thing about Halloween is putting on a costume and being someone—or something—else for a day.  What we wear can profoundly change our attitudes and behaviors, so in some ways, we actually can become someone completely different on Halloween, and it’s SO MUCH FUN!

The person in this costume is having the most fun.

But imagine becoming someone else without warning.  Like Nicki Minaj suddenly transforming into Roman Zolanski or Queen Bey turning into Sasha Fierce, you had the same body but took on an entirely new persona with a completely different past?  Instead of wearing the costume, you are the costume?!  Wait, what?

Nicki/Roman at the 2012 Grammys. omg lol this performance was such a hot mess… Click at your own risk if you missed it.

I’m talking about dissociative identity disorder (DID) a.k.a. multiple personality disorder (MPD) a.k.a. split personality disorder.  If you suffer from DID, you might wake up on November 1st not remembering anything that has happened in the past 24 hours, because you have spent your Halloween as someone else (if you’d like to experience this without DID, refer to this list from BuzzFeed).

dissociation

What is DID?

According to the the Fifth Edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-5)1, the presenting symptoms of DID, observable by others or self-reported, are:

  1. Disruption of identity characterized by 2 or more distinct personality states or an experience of possession… marked discontinuity in sense of self and sense of agency…
  2. Recurrent gaps in the recall of everyday events, important personal information, and/or traumatic events that are inconsistent with ordinary forgetting.
  3. The symptoms cause clinically significant distress or impairment in social, occupational, or other important areas of functioning.
  4. The disturbance is not a normal part of broadly accepted culture or religious practice.
  5. The symptoms are not attributable to the direct psychological effects of a substance or other medical condition.

For a better understanding of the condition, let’s take a look at a classic case of DID…

Sybil*

In 1973, Flora Rheta Schreiber published a detailed description of Sybil (a pseudonym for Shirley Ardell Mason, a former patient of psychiatrist Cornelia Wilbur) who exhibited 16 different personalities.  A movie adaptation of the book in 1976 featured the terrifyingly talented Sally Field in her Emmy-winning role as Sybil.  According to Schreiber, Mason’s DID resulted from childhood trauma.

Sally as Sybil

Sally Field as Sybil Dorsett

Although this was not the first popular reference to DID (see The Three Faces of Eve from 1957), the popularity of Sybil’s story triggered “an epidemic of diagnosis”1.

“You’re afraid of the people, and the people is your mother!!!” – Dr. Wilbur
Sybil’s mama was a mean lady who did mean things, so now Sybil is 16 people.

Sybil’s was an archetypal case of DID.  Upon investigation, however, it was discovered that the real Sybil, Shirley Mason, was not abused as a child.  She had even admitted to another psychiatrist, Herbert Spiegel (strangely, the father of D. Spiegel of ref. 1), that she only enacted her multiple personalities to please Dr. Wilbur!  It was later revealed that the relationship between the psychiatrist and patient was inappropriately intimate, and the two even lived together at one point!

“Who dat who say who dat who say who dat?”
Sybil’s love interest (slash creepy neighbor) Richard Loomis was such a catch… too bad Sybil had too many personalities (and was probably in love with Dr. Wilbur anyway). Ugh!!

For more cases of DID in pop culture, see this fascinating list from Wikipedia.   Movie night, anyone?

Some statistics

Despite the revelation of Sybil’s fraud, DID continues to be diagnosed.  Although its prevalence is unknown, it is potentially as high as 1% (the same as schizophrenia)1!  The prevalence of DID cases in academic literature, however, has dropped since it peaked in the 90s, suggesting that it was just a fad.

DID's a fad

The incidence of DID in psychology, medicine, and U.S. law increased sharply, then decreased in the 90s. Hmmm…
Data complied from Paris, 2012 (1970-2009) and Frankel & Dalenberg, 2006 (1971-2005).

While DID rates surged and then dropped, cases of three reference disorders, anorexia nervosa, alcohol abuse, and schizophrenia, have increased or plateaued steadily:

Pope

Figure from Pope, 2012: “The Rise and Fall of Dissociative Identity Disorder”

Another curious statistic, reported by Boysen & VanBergen, is that just over two-thirds of all new DID cases are accounted for by just five research groups:

DID by researcher

Cases cluster around very few researchers and research groups. Why is this?
Data from Boysen & VanBergen (2013).

Sybil’s story and strange statistics have led many to question the validity of DID.  Are all people with DID imposters?   (Click image to enlarge!)

etiology of DID 2

DID and the Law: Things to Consider

  1.  DID may lead (and has led) to the false accusation of sexual abusers.  There may be no other “proof” of abuse except for a recovered memory (which are often, though not always, unreliable).
  2.  DID may lead to the false innocence of a criminal with multiple personalities–but see Lewis et al. for some legit investigation into 12 murderers who probably actually had DID.
  3.  Who legally represents the full person?  Do the other personalities, besides the primary, deserve individual rights?
writing samples

Writing samples from “Subject 10.” As a child, he experienced hallucinations, amnesia, dizziness, and epilepsy. As an adult, he experienced trances/dreamlike states, time loss, command hallucinations, and amnesia. He had four male personality states with voice and demeanor changes and different names. As a child, he was beaten, sexually abused, and abandoned.  As an adult, he committed murder.  
From Lewis et al. (1997).

Other things to consider, courtesy of A.A.T. Simone Reinders: 

  • Traumatized children may be hyper-suggestible
  • Subjects reporting recovered childhood trauma memories more frequently falsely recall and recognize words
  • Patients with DID are more easily hypnotized
  • Patients with DID have impaired memory for traumatic words

All of these thoughts are making us anxious…

References:

1.   Spiegel, D. et al. Dissociative disorders in DSM-5. Depress. Anxiety 28, 824–52 (2011).

2.   Paris, J. The rise and fall of dissociative identity disorder. J. Nerv. Ment. Dis. 200, 1076–9 (2012).

3.   Frankel, A. S. & Dalenberg, C. The forensic evaluation of dissociation and persons diagnosed with dissociative identity disorder: searching for convergence. Psychiatr. Clin. North Am. 29, 169–84, x (2006).

4.   Pope, H. G., Barry, S., Bodkin, A. & Hudson, J. I. Tracking scientific interest in the dissociative disorders: a study of scientific publication output 1984-2003. Psychother. Psychosom. 75, 19–24 (2006).

5.   Boysen, G. A. & VanBergen, A. A review of published research on adult dissociative identity disorder: 2000-2010. J. Nerv. Ment. Dis. 201, 5–11 (2013).

6.   Reinders, A. A. T. S. Cross-examining dissociative identity disorder: neuroimaging and etiology on trial. Neurocase 14, 44–53 (2008).

7.   Gleaves, D. H. The sociocognitive model of dissociative identity disorder: a reexamination of the evidence. Psychol. Bull. 120, 42–59 (1996).

8.   Lewis, D. O., Yeager, C. A., Swica, Y., Pincus, J. H. & Lewis, M. Objective documentation of child abuse and dissociation in 12 murderers with dissociative identity disorder. Am. J. Psychiatry 154, 1703–10 (1997).

* I cannot discuss Sybil without giving a shout-out to two of my favorite Sybil-philes, Jenny Vallancourt and Callie Wilson.  If it were not for their Sybil-athon in our suite at Barnard a few years ago, this post might not exist!  The people!

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