The National Alliance on Mental Illness (NAMI), a premier organization supporting individuals with mental illness, and their families, published this Fact Sheet where they inform consumers that there is huge controversy surrounding this diagnosis and treatment, yet they are not compelled to remove it from their site. Therefore, NAMI gives the impression that Dissociative Identity Disorder (DID) is an acceptable diagnostic category and mainstream instead of taking a stance one way or the other.
NAMI, being a resource for many mental health care consumers and their families, misleads those in need of treatment. The National Alliance on Mental Illness has a responsibility to inform consumers of the following:
- treatment for multiple personalities, resulting in a diagnosis of Dissociative Identity Disorder, may result in a need for extensive psychotherapy that often lasts years or decades.
- treatment is expensive
- treatment is unlikely to be covered by insurance
- treatment is chaotic and will disrupt family harmony
- treatment has led to severe and lifelong disability in some cases
Dr. Duckworth and Dr. Freeman are listed as “reviewers” of the pdf file below. I do not know what NAMI means by reviewer, but I take it to mean they did not write the article. If I am in error, perhaps NAMI will correct me.
Support for Dissociative Identity Disorder (DID) without informing consumers and their families about the controversy is a shameful and irresponsible act. Failing to do so makes me question everything else they say on their site.
About the reviewers of this Fact Sheet:
Kenneth Duckworth, MD (medical doctor): Medical director for NAMI, the National Alliance on Mental Illness. Doard certified in adult and child and adolescent psychiatry; and a forensic psychiatry fellowship.An Assistant Clinical Professor at Harvard University Medical School and works as Associate Medical Director for Behavioral Health at Blue Cross and Blue Shield of Massachusetts.Attended the University of Michigan and Temple University School of Medicine.
He is also a family member of a person living with mental illness.
Jacob Freeman, MD (medical doctor) resident in psychiatry at The Harvard Longwood Psychiatry Residency Training Program in Boston, Massachusetts.A graduate of The College of William and Mary and The University of Massachusetts Medical School.
About the National Alliance on Mental Illness from their website: www.NAMI.org
NAMI is the nation’s largest grassroots mental health organization dedicated to building better lives for the millions of Americans affected by mental illness. NAMI advocates for access to services, treatment, supports and research and is steadfast in its commitment to raising awareness and building a community of hope for all of those in need.
From its inception in 1979, NAMI has been dedicated to improving the lives of individuals and families affected by mental illness. Financial contributions allow NAMI to offer an array of programs, initiatives and activities in support of the NAMI mission.
Dissociative Disorders FACT SHEET, pdf
NAMI • The National Alliance on Mental Illness
What is dissociation?
A number of people with mental illnesses experience dissociation: a disturbance of thinking, awareness, identity, consciousness or memory. Dissociation is more severe than just ordinary forgetfulness and is also not associated with any underlying cause of memory deficits or altered consciousness (e.g., neurological illnesses, substance or alcohol abuse). Some people have dissociative events that last only moments where as others experience extended periods of dissociation.
Some people will experience having limited ability to regulate their bodily functions and may feel like they are “going crazy” or are “out of my body” during dissociative events. Other people may lose control of their emotions or actions during a dissociative event and can do things that are otherwise quite uncharacteristic. Some people will have limited memory of the dissociative event and may feel surprised or disoriented when it ends. Many people may later recall what happened during their dissociation, but others may not be able to remember significant parts of what occurred, sometimes for even for a time before they dissociated.
There is an association between traumatic events and the process of dissociation. It may be that dissociation is a way the mind/brain contends with overwhelming stimuli. There is much more to be learned about the process of dissociation and the best strategies to address it. Dissociation can be part of a symptom of an existing mental illness. For example, many people who have experienced a traumatic event, such as physical or sexual abuse, may have some aspect of dissociation during the event itself and will be unable to recall details regarding their victimization. Dissociation can be a symptom associated with posttraumatic stress disorder (PTSD) and with certain anxiety disorders, including panic disorder and obsessive-compulsive disorder.
What are dissociative disorders?
Dissociative disorders are a controversial sub-group of mental illnesses. The most dramatic condition in this area is called dissociative identity disorder, formerly called multiple personality disorder. The media has a history of sensational portrayals of dissociative and of persons who have pretended to have dissociative illnesses in order to avoid criminal charges. Researchers, clinicians, and the public alike find the topic compelling and challenging to understand.
There is controversy over whether or not dissociative disorders are over diagnosed or improperly diagnosed by certain mental health professionals. This is an ongoing debate that is unlikely to be resolved soon.
In rare cases, some individuals have severe symptoms of dissociation in the absence of another primary mental or medical illness. In these situations, the DSM-IV-TR lists criteria by which dissociative disorders may be diagnosed. Dissociative disorders as defined by the DSM-IV-TR include:
• Dissociative amnesia—characterized by severe impairment in remembering important information about one’s self. This is perhaps the most common of the dissociative disorders and—like all other dissociative illnesses—is associated with traumatic events. This amnesia can be limited to specific details or events but can also encompass entire aspects of a person’s life.
• Dissociative fugue—a massive disorientation of self that leads to confusion about one’s personal identity and potentially the assumption of a new identity
• Depersonalization disorder—marked by recurrent feelings of detachment or distance from one’s own experiences and can be associated with the experience that the world is unreal. While many people experience these sensations at one point in their lives, an individual with depersonalization disorder has this experience so frequently or severely that it interrupts his or her functioning.
• Dissociative identify disorder (DID)—previously called multiple personality disorder, DID is the most famous and controversial of the dissociative disorders. This is characterized by having multiple “alters” (personal identities) that control an individual’s behavior and actions at different times.
What are some available treatments?
In patients where dissociation is thought to be a symptom of another mental illness (e.g., borderline personality disorder or PTSD), treatment of the primary cause is of upmost importance. This can involve psychotherapy and psychiatric medications when appropriate. It is important to note that there is no clear consensus on the treatment of dissociative symptoms themselves with medications for it is unclear whether or not psychiatric drugs can help to decrease symptoms of dissociation and depersonalization.
Psychotherapy is generally helpful for people who experience dissociative episodes. Different cognitive behavioral therapy (CBT) and dialectical behavioral therapy (DBT) techniques have been specifically developed by mental health professionals to decrease symptom frequency and improve coping strategies for the experience of dissociation.
As with any mental illness, the caring support of loved ones cannot be underestimated, particularly for individuals with a traumatic past.
Reviewed by Ken Duckworth, M.D., and Jacob L. Freedman, M.D., November 2012
Kenneth Duckworth, MD bio http://www.bu.edu/cpr/webcast/colloquium/duckworth-profile.html
Kenneth Duckworth, MD Question & Answer interview: http://www.authorsden.com/visit/viewArticle.asp?id=19640