Is Multiple Personality Disorder a Valid Diagnosis?

University Degree Biological Sciences

March 1, 2004

Dena Shuayto

Dr. Wagner

Psy. 190 Current Issues in Psychology

Is Multiple Personality Disorder a Valid Diagnosis?

According to the DSM-IV, the following criteria must be present in a patient in order to be diagnosed with Dissociative Identity Disorder (formerly Multiple Personality Disorder):

The patient has at least two distinct identities or personality states. Each of these has its own, relatively lasting pattern of sensing, thinking about and relating to self and environment.
At least two of these personalities repeatedly assume control of the patient's behavior.
Common forgetfulness cannot explain the patient's extensive inability to remember important personal information.
This behavior is not directly caused by substance use (such as alcoholic blackouts) or by a general medical condition

Dissociative Disorders are strongly linked to both Somatoform and Factitious Disorders, at times sharing similar features of behavior or traits. In the past, as noted by Mr. McHugh’s somewhat sarcastic counterpoint, they were categorized under “hysterical neurosis” which, incidentally, takes its namesake from the Greek root word for uterus; primarily a “wandering uterus” thought to cause such hysterical problems in women! Even though Multiple Personality Disorders share some features with what he refers to as “hysteria” the DSM-IV stringently outlines presenting features that overtly differentiate the two classes.

In his dissenting argument, Mr. McHugh argues rather feebly that MPD (now DID) is a “socially created artifact” drawing on archaic and stereotyped behaviors of what appears cloaked in the obscurity of Hypochondria (a somatoform disorder.) However, I do agree with his opinion on the power of playing a “victim” and the “sick role” to get attention.

I was surprised, with his obvious breadth of knowledge, he did not express the reality of these self-centered pathologies seen in these types of patients, making the connection, however superficial.

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In his dissenting argument, Mr. McHugh argues rather feebly that MPD (now DID) is a “socially created artifact” drawing on archaic and stereotyped behaviors of what appears cloaked in the obscurity of Hypochondria (a somatoform disorder.) However, I do agree with his opinion on the power of playing a “victim” and the “sick role” to get attention.

I was surprised, with his obvious breadth of knowledge, he did not express the reality of these self-centered pathologies seen in these types of patients, making the connection, however superficial.

Instead, he points out, the patients he has seen (mostly women), have been “stuck in the process of therapy” and early in the process of therapy were “offered a fairly crude suggestion that they might harbor some ‘alter’ personalities.” Even though I disagree with his biased opinion on the validity of MPD, I can see why he may have become jaded in his assertions that this disease is pure fabrication. Perhaps in many cases it is. Unfortunately, many practitioners become “patsies” to fad disorders while failing to take the more reasonable but complicated approach to Psychopatholgy ( i.e. investigating each component of influence implicated in the Multidimensional Integrative Approach: biological, social, behavioral and emotional/cognitive.)

Having said that, over the years, many “disorders” have fallen out of favor (with the APA and other governing bodies), later being either reclassified or eliminated altogether (such as the case with Homosexuality which was declassified in 1973.) Opinions and therefore diagnostic classifications are based on everything from reliability and “agreeability” of diagnosis classification, to the bias and social stereotypes of popular opinion of the times. The culture-specific debates and cross-examination that goes on every time the DSM is updated is not without vociferous controversy and frustration.

It is my opinion that MPD, like all mental disorders, has the possibility of being misdiagnosed. While I sympathize with patients suffering from real or even imagined illness, I do agree with Mr. McHugh’s contentions of the “advantages of the sick role” and persons who seek this role without a “ticket of admission.” I have no doubt that an inordinate amount of patients, who are convinced they have this disorder, are in fact suffering from a bit of a self-fulfilling prophecy rather than a valid mental disorder.

And that is the controversy: discerning a mental disorder without the benefit of an indisputable basis for diagnosis has always been the case throughout the history of medicine.

Human thinking and behavior has, and will be, subject to interpretation. This is precisely why, when appropriate, scientific analysis must be applied. Even identifying those who are truly ill, from those who may be susceptible of “playing the part” (e.g. through eliciting “alters” or via suggestive methodologies introduced during therapy) is not without fervent controversy between the most schooled of professionals.

To that end, Mr. Putnam clearly outlines the criteria of validity: content, construct and criterion. He leaves little “wiggle room” for even the staunchest detractors when debating this subject. He states that:

“content validity is probably the most fundamental form of psychiatiric diagnosis…requiring the diagnostician to be able to give a specific and detailed clinical description of the disorder.”

Also, he confronts and answers each allegation proposed by Mr. McHugh. From “therapeutic misconduct” on the part of the therapist, to inducement by media portrayals, and finally the idea that cases are increasing “exponentially”, Mr. Putnam puts each erroneous argument to rest. Most notably is the effect of increased awareness of these seemingly epidemics of syndromes. He points out:

“When symptoms that were once viewed as unrealated are organized into a coherent syndromal presentation and that information is widely disseminated, physicians begin to identify the condition more frequently.”

Finally, he backs up point after point with data, studies and peer review, supporting his position that MPD is a valid mental disorder. I tend to agree.