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Abid Ali BS 2nd year Seat No. B-1016002

Dissociative identity disorder (DID) was formerly known as multiple personality disorder (as recorded in DSM-III). In 1994, the American Psychiatric Association's (APA) DSM-IV replaced the name of Multiple Personality Disorder (MPD) with Dissociative Identity Disorder (DID). The APA in the second edition of the DSM characterizes this order by the feature of alterations in state of consciousness or identity which result amnesia, somnambulism, fugue and multiple personality*. The word alters in DID is sometimes referred to ego states; however Watkins and Watkins draw a distinction between the two concepts. They define ego state as an organized system of behavior and experience whose elements are bound together by some common principle and which is separated from other such states by boundaries that are more or less permeable. They differentiate the concept of ego states fro alters because in DID personalities have their own identities with distinct self representation that is very different from how patient is generally perceived. The personalities in DID have their own autobiographic memories and they can differentiate between what is done by their own personality and what is done by the alter. The DID patients have a sense of owner ship for what their original personality do and they may lack a sense of responsibility and owner ship for what their alter do (Watkins JG, 1998) .

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According to DSM-IV a person will said to be suffering with DID if the person shows two or more distinct personalities recurrently*. According to researchers and practitioners DID is a result of exposure to situations of extreme ambivalence and abuse in early childhood that are tackled with by a denial, so that the child believes that these events have happened to someone else (Watkins JG, et al, 1998). These researchers believe that if traumatic events occur in early child hood it is filled by DID while a traumatic event will show symptoms of PTSD if experienced in adult life (Waseem M, et al, 2009) (Herman, 2006) has characterized DID as a disorder of extreme stress, a possible form of complex PTSD that occur due to prolonged/repeated trauma. Another research suggests that the tendency to dissociate seems to be related very much to a pathogenic family structure. If the parenting style toward child is usually authoritarian and rigid and attachment disorder acquired early in the life of the child then the child is more likely to get a DID personality ( Korol S., 2008-9) More recently controversy has aroused about the diagnosis of DID. Reason for the controversy roots in the dispute over the meaning of observed symptoms, is DID a disorder with a unique set of symptoms and behaviors that some clinicians do not see when it is before their eyes? (Kluft RP, 2006) Or is it willful malingering that causes symptoms created by the other clinicians who think something is there that actually is not? (Spanos NP, 1986). Another important reason for the controversy over DID is that criminals can use it in their favor. (Keyes D., 1982). Many authors have argued (frankel, 1990) (Ganaway, 1995), ( McHugh,1995) on the basis of their case studies that hypnotic suggestions, misdiagnosis and kind of fascination

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towards disease may be the reason. These authors have argued that the patients who have been described as DID are highly hypnotizable, which implies they are very suggestible either by direct or implicit hypnotic suggestion. A few researchers also call DID a secondary phenomenon of border line personality. To them there are very few differences between the symptoms of these two diseases. They take it as a syndrome which arise at some tine I border line personalities (Luer J. et al, 1993) The defenders of the DID diagnosis, and treatment argue that the disease is currently under diagnosis. Moreover the disease is hard to be diagnosed due to its complexity which makes it very difficult to identify this disease. Dr. Philip M. Coons of Psychiatry at the Indiana University School of Medicine claims that there is a professional reluctance to diagnose multiple personality disorder (DID)." He is of the opinion that this complexity arise from a multiplicity of factors from a number of factors that include the generally subtle presentation of the symptoms, the fear of patient to towards revealing pieces of clinically important information. To Dr. Philip professional ignorance of dissociative disorders, and the reluctance of the clinician to believe the disease is real and that it is not a product of person`s fantasy (Coons, 1986). At the end we may conclude that although thousands of verified cases of DID have been reported but it should be noted that books and films have had a strong influence on the belief in the nature of DID/MPD. E.g. Sybil (a famous book 1973 and movie 1976) and, The Three Faces of Eve, The Five of Me, or The Minds of Billy Milligan, movies have not only influenced general publics notion of what the disease is but these have also affected DID/MPD patients. For example before the publication and dramatization of Sybil, there had been only about 75 reported cases of DID/MPD while after Sybil there have some 40,000 diagnoses of DID/MPD, mostly in

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North America. But some may also argue on this, that may be these movies have given DID patients of what they have been going through.

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References
*American Psychiatric Association (1968). "Hysterical Neurosis". Diagnostic and statistical manual of mental disorders second edition. Washington, D.C.. pp. 40. *American Psychiatric Association (2000-06). Diagnostic and Statistical Manual of Mental Disorders-IV (Text Revision). Arlington, VA, USA: American Psychiatric Publishing, Inc.. pp. 526529. DOI:10.1176/appi.books.9780890423349. Coons, P.M. (1986). "Child abuse and multiple personality: review of the literature and suggestions for treatment." International Journal of Child Abuse and Neglect, 10, 455-462 Frankel FH., (1990) Hypnotizability and dissociation. Am J Psychiatry.;147:823829. Ganaway GK., (1995) Hypnosis, childhood trauma, and dissociative identity disorder: toward an integrative theory. Int J Clin Exp Hypn.;43:127144. Herman J. (2006) Complex PTSD: a syndrome in survivors of prolonged and repeated trauma. J Traumat Stress.; 5:377391. Kluft RP. (2006) Dealing with alters: a pragmatic clinical perspective. Psychiatr Clin North Am.;29(1):281304. Korol S. (2008-9) Familial and social support as protective factors against the development of dissociative identity disorder. J Trauma Dissociation. (2):249267. Lauer J, Black DW, Keen P. (1993) Multiple personality disorder and borderline personality disorder: distinct entities or variations on a common theme? Ann Clin Psychiatry.;5:129134. McHugh PR. (1995) Dissociative identity disorder as a socially constructed artifact. J Practy Psychiatr Behav Health.;1:158166.

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Spanos NP. (1986) Hypnosis, nonvolitional responding, and multiple personality: a social psychological perspective. Prog Exp Pers Res.;14:162. Waseem M, Aslam M. (2009). Child abuse and neglect: dissociative identity disorder. Watkins JG, Watkins HH. (1998) The management of malevolent ego states in multiple personality disorder. Dissociation.;1(1):6771.

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