Dissociative Identity Disorder
SUBMITTED TO: MISS LAIBA KHAN
MAHNOOR 1927 | ENGLISH 2 | 16 OCT 2023
Contents
ABSTRACT: -------------------------------------------------------------------------------------------- 2
INTRODUCTION: ------------------------------------------------------------------------------------ 2
CAUSES: ------------------------------------------------------------------------------------------------ 3
SYMPTOMS: ------------------------------------------------------------------------------------------- 3
COMPLICATIONS: ----------------------------------------------------------------------------------- 4
TREATMENT: ----------------------------------------------------------------------------------------- 4
PREVENTION: ---------------------------------------------------------------------------------------- 4
MTHH ABOUT DISSOCIATIVE IDENTITY DISORDER ---------------------------------------- 4
MYTH: DID IS OBVIOUS ---------------------------------------------------------------------------- 5
MYTH: PEOPLE WITH DID ARE DANGEROUS ---------------------------------------------- 5
MYTH: DID IS A RARE CONDITION ----------------------------------------------------------- 5
MYTH: THERE IS NO EFFECTIVE TREATMENT --------------------------------------------- 5
MYTH: HEALTH CARE PROVIDERS CONVINCE PATIENTS ABOUT PAST TRAUMA
THAT THIS IS NOT TRUE ------------------------------------------------------------------------ 5
DISSOCIATIVE IDENTITY DISORDER CASE STUDY: ------------------------------------------ 6
WHAT WAS BILLY MILLIGAN DIAGNOSED WITH, WHO DIAGNOSED HIM AND
HOW HAS THE DEFINITION OF THAT DIAGNOSIS CHANGED SINCE HIS TRIAL? - 6
WHAT EVIDENCE DID MILLIGAN'S DEFENSE TEAM PRESENT TO SUPPORT THE
CLAIM THAT HE HAD MULTIPLE PERSONALITIES AND WAS NOT RESPONSIBLE
FOR HIS CRIMES? --------------------------------------------------------------------------------- 7
MILLIGAN WAS ACQUITTED BY A JUDGE. DID THE PROSECUTION CHALLENGE
THE VERDICT? ------------------------------------------------------------------------------------ 8
DO THINK MILLIGAN'S DEFENSE TEAM WOULD BE SUCCESSFUL IF THE CASE
WERE TRIED TODAY?---------------------------------------------------------------------------- 8
ARE THERE OTHER NOTABLE CASES WHERE DID HAS BEEN USED AS A DEFENSE?
IS IT STILL USED IN THE COURTROOM – AND IF SO, HOW OFTEN? ----------------- 9
CAN SOMEONE WITH DISSOCIATIVE PERSONALITY DISORDER BE HELD
ACCOUNTABLE FOR MURDER OR OTHER SERIOUS CRIMES? -------------------------- 9
CONCLUSION: --------------------------------------------------------------------------------------- 10
BIBLIOGRAPHY: ------------------------------------------------------------------------------------- 10
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ABSTRACT:
Dissociative identity disorder (DID) is a rare psychiatric disorder diagnosed in about
1.5% of the global population. This disorder is often misdiagnosed and often requires
multiple evaluations for an accurate diagnosis. Patients often exhibit self-injurious
behavior and suicide attempts. This activity reviews the assessment and treatment of
dissociative identity disorder and explains the role of the interprofessional team in caring
for patients diagnosed with dissociative identity disorder (DID). This activity also
assesses the link between DID and suicidal behavior.
INTRODUCTION:
Dissociative identity disorder (DID) is a rare disorder associated with severe
behavioral symptoms. DID was previously known as Multiple Personality Disorder until
1994. Approximately 1.5% of the population internationally has been diagnosed with
Dissociative Identity Disorder. Patients with this diagnosis often have multiple acute
conditions, often with self-injurious behavior and even substance abuse.
It is worth noting that DID has been observed and described in several countries and
has been associated with terms such as "possession of the outside world" and "demon
possession". Several case reports have been described using these terms; however, trauma
and its connection to DID came much later.
Academic Increase in DID
7000
6000
5000
4000
3000
2000
1000
0
1988-93 1993-98 1998-2003 2003-08 2008-12
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CAUSES:
Dissociation can also occur when there has been persistent neglect or emotional abuse,
even if there has been no overt physical or sexual abuse. Findings show that in families
where parents are fearful and unpredictable, children can become dissociative.
DID is rare. It affects about 1% of the population. Women are more likely to have DID
than men.
Traumas associated with DID include:
1. Repeated physical, psychological or sexual abuse
2. Accident
3. Natural disaster
4. Being a victim of a crime
SYMPTOMS:
The diagnosis of DID is established based on the criteria outlined in the Diagnostic and
Statistical Manual of Mental Disorders, Fifth Edition (DSM-5). These criteria include:
1. Presence of two or more distinct personality states.
2. Recurrent gaps in memory, often related to switches between personality states.
3. Disruption in identity, leading to significant distress or functional impairment.
4. Exclusion of other medical or psychological conditions that may explain the
symptoms.
% Responses
Memory Loss
Hearing Voices
Dissociation
Blackouts
Amnesia
0% 20% 40% 60% 80% 100%
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COMPLICATIONS:
Having a dissociative disorder increases the risk of complications and having other
mental health conditions. These may include:
1. Depression and anxiety.
2. Post-traumatic stress disorder.
3. Sleep disorders, including nightmares, insomnia and sleepwalking.
4. Physical symptoms such as lightheadedness or seizures that are not due to
epilepsy.
5. Eating disorders.
6. Problems with sexual function.
7. Problems with alcohol and drug use.
TREATMENT:
Dissociative disorders are managed through various therapies including:
1. Psychotherapies such as cognitive behavioral therapy (CBT) and dialectical
behavioral therapy (DBT)
2. Eye movement desensitization and reprocessing (EMDR)
3. Medications such as antidepressants can treat symptoms of related conditions
PREVENTION:
There’s no way to prevent DID. But identifying the signs as early in life as possible
and seeking treatment can help you manage symptoms. Parents, caregivers and teachers
should watch for signs in young children. Treatment soon after episodes of abuse or
trauma may prevent DID from progressing.
Treatment can also help identify triggers that cause personality or identity changes.
Common triggers include stress or substance abuse. Managing stress and avoiding drugs
and alcohol may help reduce the frequency of different alters controlling your behavior
MTHH ABOUT DISSOCIATIVE IDENTITY DISORDER:
Given the amount of misinformation about the condition, it's possible that what you've heard
about DID isn't true.
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MYTH: DID IS OBVIOUS
Despite what the media may portray,
it's not easy to tell when someone has
done it. However, the experience of a
fragmented sense of self and "not me"
of thoughts, feelings, memories, and
even body image is very real for
people with DID.
Characters portrayed in the media as
having DID are often shown wearing
unusual clothing, with wildly changing mannerisms, or appearing to be a completely
different person. People with DID rarely express their identity in such overt ways.
MYTH: PEOPLE WITH DID ARE DANGEROUS
Many people with DID have been portrayed as dangerous individuals who commit
violent acts under various "personas".
People with DID are no more violent or dangerous than the general population. Their
symptoms and behavior reflect that they are afraid of dangerous situations. In fact, many
people with this condition feel intimidated by their history of childhood trauma and do
what they can to avoid drawing attention to themselves.
MYTH: DID IS A RARE CONDITION
Because DID has been poorly understood and difficult to detect, it is often called a rare
condition. In fact, DID occurs in approximately 1% of the general population. This is the
same percentage of people who have schizophrenia.
MYTH: THERE IS NO EFFECTIVE TREATMENT
DID is a serious mental condition. For many therapists not trained in dissociative
disorders, this is difficult to recognize. But with effective treatment from mental health
providers who are trained in trauma and dissociation, or are able to obtain counseling
from someone trained, people with DID can and do recover. People with DID can live
full and productive lives.
MYTH: HEALTH CARE PROVIDERS CONVINCE PATIENTS ABOUT
PAST TRAUMA THAT THIS IS NOT TRUE
One of the controversies about DID is the theory that mental health professionals induce
DID by suggesting false reports of past abuse to gullible patients. This suggests that
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therapists who obtained information from the media could somehow lead their patients to
believe that they had a history of childhood abuse when the abuse never occurred.
DISSOCIATIVE IDENTITY DISORDER CASE STUDY:
In October 1977, authorities arrested 22-year-old Billy Milligan and charged him with the
kidnapping, robbery and rape of three Ohio State University (OSU) students. An OSU
police officer who rode with Milligan to the Columbus, Ohio police headquarters told
The Columbus
Dispatch in a 2007 interview, “I couldn’t tell you what was going on, but it was like I was
talking to different people at different times.”
During a psychiatric evaluation, Milligan alleged no wrongdoing, blaming one of his
alters (or alternate identities), Ragin, for the robberies and another, Adalana, for the
kidnappings and sexual assaults. Milligan claimed to have 24 alternate personalities.
On December 4, 1978, in a landmark trial, Milligan became the first defendant found not guilty
by reason of insanity due to multiple personality disorder, reclassified in 1993 as dissociative
identity disorder.
WHAT WAS BILLY MILLIGAN DIAGNOSED WITH, WHO
DIAGNOSED HIM AND HOW HAS THE DEFINITION OF THAT
DIAGNOSIS CHANGED SINCE HIS TRIAL?
During the trial, Milligan was diagnosed with multiple personality disorder or MPD. He
was evaluated by nine different mental health professionals. His most famous evaluator
was a woman named Cornelia Wilbur, a psychiatrist best known for the [1973] book
‘Sybil,’ [which recounted] a groundbreaking [1950s-era] examination of someone who
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had these multiple personalities with different behaviors and mannerisms. [It followed the
1957 book about the subject,] ‘The Three
Faces of Eve‘ [about a woman named Chris Costner Sizemore who was diagnosed with
MPD]. These books started a phenomenon. And MPD…was the diagnosis that Milligan
received.
At the time, it was believed multiple personality disorder was caused by trauma, and that
these individuals under trauma, because they couldn’t physically escape, mentally
escaped by creating these different forms within themselves. It was a controversial
diagnosis. Our understanding as mental health professionals has changed in terms of how
we see what MPD was then. Now, it’s been renamed dissociative identity disorder, or
DID, to reflect a difference in understanding. Rather than having all these different
personalities running around, with DID it’s more like trauma causes a person to almost
not be fully developed. They may kind of split off parts of themselves and have trouble,
for example, experiencing certain emotions or feel like they are outside of themselves
when they get in certain situations or things don’t seem real.
WHAT EVIDENCE DID MILLIGAN'S DEFENSE TEAM PRESENT TO
SUPPORT THE CLAIM THAT HE HAD MULTIPLE PERSONALITIES
AND WAS NOT RESPONSIBLE FOR HIS CRIMES?
Milligan was in a mental institution before committing these crimes. He was actually a
teenager when he was hospitalized for various psychiatric problems and diagnosed with
what was then called a hysterical neurosis. There were two subcategories: conversion
type and dissociative type. The dissociative type of hysterical neurosis that was Milligan's
diagnosis involved changes in the patient's state of consciousness or identity that
produced such symptoms as amnesia, somnambulism [a form of sleepwalking], fugue
[loss of awareness of one's own identity], and multiple personality.
Milligan's defense team was able to come back and show that he wandered off several
times at various stages of his upbringing and was prone to scatting. There was some
evidence that he had some dissociative qualities in his background. Of course, he also
claimed to have a history of trauma, which would be something you would look for if
you are diagnosing someone with MPD. He claimed he was sexually abused by his
stepfather. [His stepfather denied the allegations and was never charged.]
At the time of his crimes, at least one police officer thought he was behaving very
strangely and seemed to switch personalities. One of his victims described him as soft-
spoken and well-spoken, while another claimed he had an accent. So observing behavior
from other people suggested that he might have some dissociative symptoms. It gets a
little murky because he also had an extensive criminal history. I think the social
environment and media attention around MPD influenced the way many people
conceptualized the case.
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MILLIGAN WAS ACQUITTED BY A JUDGE. DID THE
PROSECUTION CHALLENGE THE VERDICT?
They did not challenge the verdict. They accepted the argument because nine different
people evaluated him. The judge acquitted him, and the prosecution did not contest the
ruling.
Milligan was the first ever defendant to be found not guilty of multiple personality
disorder, now known as dissociative personality disorder. Did his case set any legal
precedents?
I'm not a lawyer so I don't want to talk too much about legal precedent. However, I don't
think the Milligan case sparked anything.
In general, a plea of insanity is a hard road to hoe. It was then and it's even harder now. I
can't imagine what legal precedent his case would set because they use a diagnosis to
argue the existing legal definition of insanity. They tried to say that because of his mental
illness he was unable to appreciate that what he was doing was wrong and therefore not
criminally responsible. The diagnosis did not change what was required. It was
considered crazy from a legal point of view, it just said that this is an example of what
would work.
DO THINK MILLIGAN'S DEFENSE TEAM WOULD BE SUCCESSFUL
IF THE CASE WERE TRIED TODAY?
Today I don't think he would be found legally insane. Most people who commit violent
crimes are not mentally ill. When I am asked to do a criminal responsibility assessment, it
is someone who has potentially committed a violent crime and there is some suspicion or
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diagnosis of mental illness. The question is, 'If this person is mentally ill, does their crime
have anything to do with their mental illness?' Mostly the answer is no.
In the case of Billy Milligan, for the sake of argument, let's say he had MPD. For him to
be found legally insane, it would be because of his mental illness. What in his mental
illness drove him to rape? There must be some direct connection between a person's
symptoms and the crime he committed.
ARE THERE OTHER NOTABLE CASES WHERE DID HAS BEEN
USED AS A DEFENSE? IS IT STILL USED IN THE COURTROOM –
AND IF SO, HOW OFTEN?
There was a case involving a man named Tom Bonney. In November 1987, he shot his
daughter 27 times. Bonney already had a history of mood swings and anger management
issues, but there was no evidence of MPD until this particular psychologist named Paul
Dell called Bonnie's defense attorney and offered to evaluate him. Until then, no one
thought Bonney had MPD or anything like that. They tried to use it to defend him, but
there were all sorts of problems. Before ever meeting and evaluating Bonney, the
psychologist suggested he had MPD. The opposing psychiatrist, who was for the
prosecution, reviewed the evaluation and pointed out all the instances where Dr. Dell was
extremely suggestive.
Another famous case involves Kenneth Bianchi, the 'Hillside Strangler'. He managed to
convince four mental health experts that his alter Steve Walker had committed the
murders. He tried all these other strategies and nothing worked. Then suddenly he
developed MPD. Fortunately, there was another psychiatrist who was much smarter and
challenged the diagnosis. Bianchi eventually admitted he lied and took a plea deal to
avoid the death penalty.
In 2014, Milligan died from cancer at the age of 59.
CAN SOMEONE WITH DISSOCIATIVE PERSONALITY DISORDER
BE HELD ACCOUNTABLE FOR MURDER OR OTHER SERIOUS
CRIMES?
There must be a direct link between the symptoms and the person's criminal behavior.
Otherwise it simply reads:
'This person has committed a violent crime and has a mental illness'.
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CONCLUSION:
Dissociative Identity Disorder remains a complex and poorly understood condition that
challenges clinicians and researchers alike. It is essential to raise awareness, reduce
stigma, and improve diagnostic accuracy to ensure that individuals with DID receive the
appropriate care and support they need.
BIBLIOGRAPHY:
Ferri FF. Dissociative disorders. In: Ferri's Clinical Advisor 2023. Elsevier; 2023.
[Link] Accessed May 16, 2023
Dissociative disorders. In: Diagnostic and Statistical Manual of Mental Disorders DSM-5-TR. 5th
ed. American Psychiatric Association; 2022. [Link] Accessed May 15,
2023.
American Association for Marriage and Family Therapy. Dissociative Identity Disorder
([Link] Accessed
6/3/2021.
Child Mind Institute. The Most Common Misdiagnoses in Children
([Link] Accessed 6/3/2021.
Homepage. (n.d.). A+E Networks EMEA. Retrieved October 17, 2023, from
[Link]
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