A Group of Concerned Psychiatrists and Psychologists
c/o Dr. Paul McHugh, MD
Distinguished Service Professor of Psychiatry
Johns Hopkins University
April 11, 2009
Dr. David J. Kupfer, MD
Chair of DSM-V Committee,
Dr. Thomas Detre Professor and Chair, Department of Psychiatry
Professor of Neuroscience, Western Psychiatric Institute and Clinic
5811 O’Hara Street
Pittsburgh, PA 15215
RE: Dissociative Identity Disorder and DSM-V
Dear Dr. Kupfer:
We are writing to you to express concern with respect to the continuation of Dissociative
Identity Disorder as an approved diagnosis within the forthcoming DSM-V. We believe that
the identification of Multiple Personality Disorder, and later its name change as Dissociative
Identity Disorder, has been harmful to the good sense and reputation of psychiatry, not to
mention the cause of grave ill-effects to large numbers of patients and their families. In the
attached document we maintain that the diagnosis should be removed from DSM-V and we
provide the basis for our request. If either the Task Force or Council is unable to agree
on removing DID completely from the 5th Edition we suggest that at the very
least it should be placed in Appendix B as an experimental criterion set
requiring further investigation.
Respectfully,
Signatories
(Please see Appendix A)
Attachments
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To: DSM-V Task Force &
Work Group on Anxiety, Obsessive-Compulsive Spectrum,
Posttraumatic & Dissociative Disorders
Statement on:
The need to remove Dissociative Identity Disorder from DSM-V or place it in Appendix B
The evidence supporting this diagnosis as a distinct mental disorder is modest whereas much
suggests it to be a behavioral artifact equivalent in nature to pseudo-epilepsy generated by
suggestion in vulnerable people. Its identification as a special, separate diagnostic entity in
DSM has harmed the practice of psychiatry and undermined its scientific credibility.
Although it is important for us to provide evidence to support these statements, we wish to
avoid excessive detail, given that such evidence has been documented widely in the published
literature.
Origins
The notion of dual personalities was founded upon cases of bipolar illness (1) and was
followed by the idea of extra personalities. This expansion first occurred with the
hypnotically-induced introduction of a second personality and the deliberate naming of those
personalities as if they were separate entities (1).
Prevalence
Taylor and Martin (2) recognized a total of 76 cases occurring between 1816 and 1944—
slightly more than one every two years; they thought a similar number might be unreported.
In 1954 Thigpen and Cleckley (3) reported their case, which was published as “The Three
Faces of Eve” in 1957. After a film was made of this case, the numbers of reported cases
increased steadily; there was a further dramatic leap after the film of “Sybil”. By 1990
thousands of cases were being diagnosed; some authors identified more cases in their personal
practices than had been described in the literature over an entire century.
Twentieth Century Suggestion
As is well known, Sybil, a patient of Dr. Cornelia Wilbur, was fully aware that her therapist
wanted her to create extra personalities (4). In 1973, Dr. Wilbur gave tape recordings of
Sybil’s interviews to Schreiber [the journalist who reported Sybil as a case of multiple
personality disorder (5)]. Schreiber made the recordings available to Ronald Rieber, a
professor of psychology, who amassed evidence showing that at least some of the
personalities were artifacts overtly created in treatment (6).
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Etiology
Dissociative Identity Disorder is often alleged to result from repressing an experience of
childhood sexual abuse. This claim has not received adequate scientific validation. For
example, Piper and Merskey (7) reviewed all the studies that claimed to corroborate DID
patients’ abuse recollections. These authors concluded that “no evidence supports the claim
that DID patients as a group have actually experienced the traumas asserted by the disorder’s
proponents” (7).
Proponents of the DID diagnosis assert that horrific, repeated childhood physical and sexual
abuse is the primary cause of DID. Victims supposedly develop their multiple personalities as
repositories for traumatic memories that the “host” personality is unable to tolerate
consciously. The DID diagnosis thus relies on the concept of traumatic Dissociative Amnesia
(DA or “repression”): the notion that the mind protects itself by banishing terrifying memories
from awareness, rendering them inaccessible until the person feels psychologically safe to
recall them, often years later. There is no convincing evidence that victims can become
incapable of recalling genuinely traumatic experiences, as the trauma theory of DID requires
(8). Indeed, an extensive survey of the historical literature, including both fictional and nonfictional written works in multiple languages, found no written example of “dissociative
amnesia” prior to 1786 (9). Thus the notion of “repressing” a memory itself, like DID,
appears to represent a recent culture-bound phenomenon, rather than a naturally occurring
human psychological process.
In a comprehensive analysis of studies of people with documented trauma histories, not a
single mention of spontaneous amnesia for the traumatic event was found—unless the
forgetting was attributable to either organic amnesia or childhood amnesia (10). Finally, an
examination of Freud’s original work gives reason to think that the evidence from
psychoanalysis for repression is also very unsatisfactory (11, 12).
Harmful Effects
Due to the assumption that trauma is a primary etiological factor, the DID diagnosis has
resulted in wrongful accusations of sexual abuse on the basis of recovered memories, not only
in North America but throughout the developed world (references). DID has caused mockery
of psychiatry, and, for patients, has led to misdiagnosis (13), mismanagement (14) and
inadequate treatment of depression (15).
Lack of Consensus
Canadian and American psychiatrists show little consensus regarding the diagnostic status and
scientific validity of DID. In surveys of board-certified psychiatrists in the United States (16)
and Canada (17) fewer than one-third of Canadian psychiatrists and 35% of American
psychiatrists replied that DA & DID should be included without reservations in the DSM-IV;
fewer than 1 in 7 Canadian psychiatrists and only 21-23% of American psychiatrists replied
that there was “strong evidence of validity” for these disorders. French- and English-speaking
Canadians had similar opinions.
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Conclusions
There are overwhelming reasons to question the validity of Dissociative Identity Disorder. We
respectfully urge you as members of the Work Group and the Task Force to drop the category
of dissociative disorders from the upcoming DSM-V: it is harmful to patients and their
families, scientifically unjustified, and undermining the credibility of psychiatry.
Signatories
Please see Appendix A.
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REFERENCES
1. Merskey, H. (1992a). The manufacture of personalities. The production of multiple
personality disorder. Brit. J. Psychiat., 160:327-340.
2. Taylor W.F. & Martin M.F. (1944) Multiple personality. J. Abnormal & Soc. Psychol.,
39:281-330.
3. Thigpen, C.H. & Cleckley, H.M. (1957). The Three Faces of Eve. New York: McGrawHill.
4. Spiegel, H. (1993) Mistaken Identities: Toronto. Canadian Broadcasting Corporation.
The Fifth Estate, 9 November 1993.
5. Schreiber, F.R. (1973) Sybil. Chicago: Henry Regnery.
6. Rieber, R.W. (2006) The Bifurcation of the Self. The History and Theory of Dissociation
and Its Disorders. New York: Springer Science.
7. Piper, A., Merskey, H., (2004). The persistence of folly: a critical examination of
dissociative identity disorder. Part I. The excesses of an improbable concept. Can J
Psychiatry 49 (9): 592-600.
8. McNally, R. J. (2003) Remembering Trauma. Belknap Press/Harvard University Press:
Cambridge, MA.
9. Pope, H.G. Jr., Poliakoff, M.B., Parker, M.P., Boynes, M.D., & Hudson, J.I. (2007) Is
dissociative amnesia a culture-bound syndrome? Findings from a survey of historical
literature. Psychol. Med., 37(2):225-233.
10. Pope, H. G. Jr., Oliva, P., Hudson, J.I.: (2005) Repressed memories. The scientific status
of research on repressed memories, in Modern Scientific Evidence: The Law and Science
of Expert Testimony—Social and Behavioral Science, 2005-2006 Edition. Edited by
Faigman D, Kaye D, Saks M, Sanders J. Eagen, MN, West Group, pp 408-447.
11. Esterson, A. (1993) Seductive Mirage. Open Court: Chicago.
12. Crews, F. (1998) Unauthorized Freud: Doubters Confront a Legend. New York: Viking.
13. Freeland, A., Manchanda, R., Chiu, S., et al. (1993) Four cases of supposed multiple
personality disorder: evidence of unjustified diagnoses. Can. J. Psychiat., 23: 245-247.
14. McHugh, Paul R. (2008) Try to Remember: Psychiatry’s Clash over Meaning, Memory,
and Mind. Chapters 4 &5. Dana Press.
15. Fetkewicz, J., Sharma, V. & Merskey, H. (2000) A note on suicidal deterioration with
recovered memory, treatment. J. Affect. Dis., 58:155-159.
16. Pope, H.G., Jr., Oliva, P.S., Hudson, J.I., Bodkin, J.A. & Gruber, A.J. (1999) Attitudes
toward DSM-IV Dissociative Disorders Diagnoses among Board-Certified American
Psychiatrists. Am. J. Psychiat., 2000; 157:1179-1180.
17. Lalonde, J.K., Hudson, J.I., Gigante, R.A. & Pope, H.G. Jr. (2001) Canadian and
American psychiatrists’ attitudes toward Dissociative Disorders diagnoses. Can. J.
Psychiat., 46(5): 407-412.
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APPENDIX A
List of Signatories
1. Paul R. McHugh, M.D. Distinguished Service Professor of Psychiatry at Johns Hopkins
University.
2. Harrison Pope, Jr., MD, MPH, Professor of Psychiatry, Harvard Medical School, Boston,
Massachusetts; Director, Biological Psychiatry Laboratory, McLean Hospital, Belmont
Massachusetts
3. James Hudson, MD, ScD, Professor of Psychiatry, Harvard Medical School, Boston,
Massachusetts; Director, Biological Psychiatry Laboratory, McLean Hospital, Belmont
Massachusetts
4. Elizabeth Loftus, PhD, Distinguished Professor, University of California-Irvine.
5. Richard J. McNally, Ph.D., Professor and Director of Clinical Training, Department of
Psychology, Harvard University, Cambridge, MA.
6. Harold Merskey, FRCPsych., Professor Emeritus of Psychiatry, University of Western
Ontario, London, Ontario
7. Joel Paris, M.D. Professor of Psychiatry, McGill University, SMBD-Jewish General
Hospital, Montreal, Quebec H3T1E4, Canada.
8. August Piper, M.D., Independent practice of psychiatry, Seattle, WA.
9. Numan Gharaibeh, MD (MB, BCh), Danbury, CT.
10. Pamela Freyd, Ph.D.
11. Eduard Vieta, M.D., Ph.D., Professor of Psychiatry, University of Barcelona, Barcelona,
Catalonia, Spain.
12. Philip G. Janicak, MD, Professor of Psychiatry, Rush University, Chicago, Il.
13. Gerald M. Rosen, Ph.D., Private practice, Seattle, Clinical Professor, University of
Washington.
14. Steven Jay Lynn, Ph.D., ABPP, Professor, Binghamton University (SUNY) Binghamton,
NY.
15. Sally Satel, MD, resident scholar American Enterprise Institute; staff psychiatry Oasis
Clinic, Washington DC; lecturer, Yale University School of Medicine.
16. James M. Wood, Ph.D. Professor, Department of Psychology, University of Texas at El
Paso.
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