Myth: DID is fake or only exists in one culture

Most people meet DID through whatever media is available to them. When the same handful of countries seems to produce nearly every public story, it can begin to look like the diagnosis belongs there too.¹

Brand and colleagues found prevalence studies using validated interviews in several countries, along with research from 48 institutions in 16 countries.¹

Boon and Draijer used the SCID-D with 71 patients in specialist care in the Netherlands and reported a core symptom pattern resembling the North American series available at the time.² They were comparing clinical symptoms; their sample couldn't establish how common DID was across the country.

The geographic reach of the research has also drawn criticism. A 2013 review of adult DID papers published from 2000 through 2010 described concentrated geographic and clinical networks and limited documented cases outside treatment.³ Access to specialists, local diagnostic habits, and language all affect who enters those records.¹ How much DID research is there? discusses that review alongside later work.

Descriptions change with culture. Sar, Dorahy, and Kruger write that Cultural processes influence the development and phenomenology of DID.⁴ A clinician may hear about parts in one setting and possession, missing time, or a spiritual experience in another.

Could someone simply act it out?

The word “fake” brings up a different question: could people reproduce identity-state changes after learning what DID is supposed to look like?⁵

In a small experiment, Reinders and colleagues compared eleven women diagnosed with DID with eighteen controls who were asked to simulate identity states. The researchers recorded psychophysiological and neural responses rather than relying only on what each participant reported. Across those measures, the states were not convincingly enacted by DID simulating controls.⁵

Kluft put the simulation problem more bluntly: Because a hypnotist convinces a subject to cluck like a chicken does not produce the genuine article!⁶

The broader suggestion that dissociation arises through fantasy or suggestibility has been tested too. Dalenberg and colleagues compared eight predictions from trauma and fantasy models across the dissociation literature. They found that dissociation was not reliably associated with suggestibility, while its relationship with trauma remained after fantasy proneness was controlled.⁷

Modesti and colleagues reviewed thirteen functional-neuroimaging studies across dissociative disorders and found recurring results in areas linked with memory, emotion regulation, self-awareness, and identity state. The authors noted that few functional neuroimaging studies currently concentrate on dissociative disorders,⁸ and the studies varied in both samples and methods.

The suggestion argument cuts both ways

One explanation for DID says that suggestion, fantasy, or the treatment relationship can teach people to organise their experiences as identity states. That is a serious hypothesis. It should also be treated as one.

Nijenhuis makes this point sharply. He writes that some critics treated fabrication as settled while ignoring that their own beliefs were hypotheses in need of empirical testing.⁹ The inverse suggestion is easy enough to imagine: if a clinician begins with the belief that DID is role-play, the person's account may be filtered through that belief before the symptoms have been properly examined.

His example is Lutz Jäncke, the neuropsychologist who agreed to work with the Groningen and Zurich teams. Nijenhuis describes the researchers as willing to test several basic biopsychosocial hypotheses of TSDP.⁹ They trained controls to simulate ANP and EP states, then measured their responses to subliminal threat cues and compared them with diagnosed DID participants. The controls still did not reproduce the same psychophysiological and neural patterns.⁵⁹

That is the part of Nijenhuis's argument I find most useful. Skepticism works best when it turns into a study: state the proposed mechanism, decide what it should produce, and see whether the data follow. Saying that suggestion might explain DID is the beginning of that process, not the end of it.

Footnotes9

Footnotes

1. Brand, B. L., Sar, V., Stavropoulos, P., Kruger, C., Korzekwa, M., Martinez-Taboas, A., & Middleton, W. (2016). Separating fact from fiction: An empirical examination of six myths about dissociative identity disorder. Harvard Review of Psychiatry, 24(4), 257-270. Underdiagnosis discussion; diagnostic delay. Review of evidence concerning prevalence, validity, causes, and treatment. ↩ ↩² ↩³

2. Boon, S., & Draijer, N. (1993). Multiple personality disorder in the Netherlands: A clinical investigation of 71 patients. American Journal of Psychiatry, 150(3), 489-494. Abstract; methods and results. SCID-D study of 71 Dutch patients reporting varied symptoms, frequent prior diagnoses, and an average 8.2 years in mental-health care before diagnosis. ↩

3. Boysen, G. A., & VanBergen, A. (2013). A review of published research on adult dissociative identity disorder: 2000-2010. Journal of Nervous and Mental Disease, 201(1), 5-11. Abstract; literature counts and conclusions. A historical review that counted 21 case studies, 80 empirical studies, and 1,171 newly reported cases while arguing that major questions remained unresolved. ↩

4. Sar, V., Dorahy, M. J., & Kruger, C. (2017). Revisiting the etiological aspects of dissociative identity disorder: A biopsychosocial perspective. Psychology Research and Behavior Management, 10, 137-146. Cultural factors. Biopsychosocial account of developmental and maintaining factors. ↩

5. Reinders, A. A. T. S., Willemsen, A. T. M., Vos, H. P. J., den Boer, J. A., & Nijenhuis, E. R. S. (2012). Fact or factitious? A psychobiological study of authentic and simulated dissociative identity states. PLOS ONE, 7(6), e39279. Abstract and conclusion. Comparison of diagnosed DID identity states with simulated identity states. ↩ ↩² ↩³

6. Kluft, R. P. (1991). Clinical presentations of multiple personality disorder. Psychiatric Clinics of North America, 14(3), 605-629. p. 607. Distinction between inducing a temporary enactment of MPD-like phenomena and producing clinical MPD. ↩

7. Dalenberg, C. J., Brand, B. L., Gleaves, D. H., Dorahy, M. J., Loewenstein, R. J., Cardena, E., Frewen, P. A., Carlson, E. B., & Spiegel, D. (2012). Evaluation of the evidence for the trauma and fantasy models of dissociation. Psychological Bulletin, 138(3), 550-588. Abstract and review of trauma-model evidence. Review evaluating competing explanations for the association between trauma and dissociative symptoms, including limits of the available evidence. ↩

8. Modesti, M. N., Rapisarda, L., Capriotti, G., & Del Casale, A. (2022). Functional neuroimaging in dissociative disorders: A systematic review. Journal of Personalized Medicine, 12(9), 1405. Limitations and conclusion. Systematic review of functional neuroimaging findings and study limitations. ↩

9. Nijenhuis, E. R. S. (2015). The trinity of trauma: Ignorance, fragility, and control, Volumes I and II. Vandenhoeck & Ruprecht. Volume II, Chapters 17-18, pp. 441-458; discussion of sociocognitive models, simulation controls, and the neuroimaging studies. Nijenhuis argues that sociocognitive explanations remain hypotheses to be tested and describes studies using trained simulation controls and neuroimaging measures. ↩ ↩² ↩³