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. This is one reason the myth sticks around. Clinical records are also shaped by access to specialists, local diagnostic habits, and the language people use for dissociation.¹

Brand and colleagues found prevalence studies using validated interviews in several countries, along with research from 48 institutions in 16 countries.¹ So, the research reaches well beyond one local diagnostic culture. Sixteen countries still leave much of the world uncounted, and differences in language and specialist access affect who is seen in the first place.

There is older clinical evidence from outside North America too. Boon and Draijer used the SCID-D with 71 patients in the Netherlands and reported a core symptom pattern resembling the North American series available at the time.² The sample came through specialist care, so it tells us about that clinical group rather than the prevalence of DID across the country.

Descriptions change with culture. Sar, Dorahy, and Kruger write that Cultural processes influence the development and phenomenology of DID.³ 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?⁴

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.⁴

That experiment only answers one part of the question. Dalenberg and colleagues took a wider look by comparing 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.⁵

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,⁶ and the studies varied in both samples and methods.

Kluft put the simulation problem more bluntly: Because a hypnotist convinces a subject to cluck like a chicken does not produce the genuine article!⁷

A 2013 review counted the adult DID papers published from 2000 through 2010 and criticised the field for small geographic and clinical networks, limited cases outside treatment, and questions that remained unresolved.⁸ That paper is useful precisely because it was not written as advocacy. How much DID research is there? compares its snapshot with work published later.

Footnotes8

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

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. 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. ↩

4. 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

5. 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. ↩

6. 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. ↩

7. 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. ↩

8. 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. ↩