International Society for the Study of Dissociation

One of the best sources I found for learning about the most up to date information regarding MPD/DID is the International Society for the Study of Dissociation. It can be found at www.issd.org



An excerpt taken from International Society of Dissociation:


I. EPIDEMIOLOGY, CLINICAL DIAGNOSIS, AND DIAGNOSTIC PROCEDURES

DID and dissociative disorders are not rare conditions. In studies of the general population, a prevalence rate of DID of one to three percent of the population has been described (Murphy, 1994; Ross, 1991; Waller & Ross, 1997), although some researchers have criticized the methodology of these studies, and have suggested a somewhat lower prevalence. Clinical studies in North America, Europe, and Turkey have found that between one to 20 percent of patients on general inpatient psychiatric units, adolescent inpatient units, and in substance abuse, eating disorders, and obsessive compulsive disorder treatment may meet DSM-IV-TR (American Psychiatric Association, 2000a) diagnostic criteria for DID, particularly when evaluated with structured diagnostic instruments. Many of these patients had not been clinically diagnosed previously with a dissociative disorder (Bliss & Jeppsen, 1985; Goff, Olin, Jenike, Baer, & Buttolph, 1992; Latz, Kramer, & Highes, 1995; McCallum, Lock, Kulla, Rorty, & Wetzel, 1992; Ross, Anderson, Fleisher, & Norton, 1991; Modestin, Ebner, Junghan, & Erni, 1995; Ross et al., 1992; Saxe et al., 1993; Tutkun et al., 1998).

Accurate clinical diagnosis affords early and appropriate treatment for the dissociative disorders. Seven studies of 719 DID patients have shown that they spent five to 11.9 years in the mental health system before they were diagnosed as having DID (Boon & Draijer, 1993a; Coons, Bowman, & Milstein, 1988; Martínez-Taboas, 1991; Middleton & Butler, 1998; Putnam, Guroff, Silberman, Barban, & Post, 1986; Rivera, 1991; Ross, Norton, & Wozney, 1989). While progress has been made in educating the professional community about the prevalence and clinical presentation of dissociative disorders, these seven studies suggest that many cases of DID and related disorders are still being missed, misdiagnosed, and inappropriately treated.

The primary difficulties in diagnosing DID result from lack of education among clinicians about dissociation, dissociative disorders, and the effects of psychological trauma. This leads to limited clinical suspicion about dissociative disorders and misconceptions about their clinical presentation. Most clinicians have been taught that DID is a rare disorder with a florid, dramatic presentation. In fact, DID is a relatively common disorder which presents with subtle symptoms in a patient who may minimize or conceal symptoms. DID patients commonly present in a polysymptomatic fashion with dissociative and PTSD symptoms embedded in a matrix of symptoms such as depression, panic, somatoform symptoms, eating disorder symptoms, etc. that may lead only to diagnosis of these co-morbid conditions. This results in long and frequently unsuccessful treatment for these other conditions.

Further, almost all practitioners were taught standard diagnostic interviewing and mental status examinations that do not include questions about dissociation, PTSD symptoms, or a history of psychological trauma. Since DID patients rarely directly volunteer information about dissociative symptoms, absent questions about such symptoms, or recognition of them when they present, the clinician cannot diagnose DID. Accordingly, the sine qua non for the diagnosis of DID is the use of diagnostic interviews that inquire about dissociation, supplemented when necessary by screening instruments and structured interviews that assess the presence or absence of dissociative symptoms.

Corresponding author: James A. Chu, MD
115 Mill St. Belmont, MA 02478
Phone: 617 855-2761 Fax: 617 855-2674
Email: james.chu@earthlink.net

Copyright 1994, 1997, and 2005 by the International Society for the Study of Dissociation. The Guidelines may be reproduced without the written permission of the International Society for the Study of Dissociation (ISSD) as long as this copyright notice is included and the address of the ISSD is included with the copy. Violations are subject to prosecution under federal copyright laws.

Additional copies of the guidelines (US $5 for members, $10 for nonmembers) can be obtained by writing to the ISSD at 60 Revere Dr., Suite 500, Northbrook, IL 60062 USA. The correct citation for this revision of the Guidelines is: International Society for the Study of Dissociation. (2005). [Chu, J.A., Loewenstein, R., Dell, P.F., Barach, P.M., Somer, E., Kluft, R.P., Gelinas, D.J., Van der Hart, O., Dalenberg, C.J., Nijenhuis, E.R.S., Bowman, E.S., Boon, S., Goodwin, J., Jacobson, M., Ross, C.A., Sar, V, Fine, C.G., Frankel, A.S., Coons, P.M., Courtois, C.A., Gold, S.N., & Howell, E.]. Guidelines for treating Dissociative Identity Disorder in adults. Journal of Trauma & Dissociation, 6(4), in press.