User talk:Vanished user 54564fd56f45f4dsa5f4sf5/Sandbox
WP DID article: "To date approximately 250 cases of DID in children have been identified"
Peer Review: To what date? See WP:ASOF.
Me: Looks like Boysen looked at published studies in the 1980's and 1990's. Boysen's exact words: "Nearly all of the research that does exist on childhood DID is from the 1980s and 1990s and does not resolve the ongoing controversies surrounding the disorder."
Peer Review: I am of the opinion that, whenever possible, every section should refer to more than one source. In children, which covers a somewhat contentious topic, only references Boysen 2011.
Me: I could not agree more about having 2 references.
WP DID paragraph: In children DID is rarely diagnosed in children. Me:{why? citation?} This fact is cited as a reason to doubt the validity of DID, and proponents of both etiologies Me:(what are both?) believe that the discovery of DID in a child that had never undergone treatment would critically undermine the SCM. Conversely the development of DID only after undergoing treatment would challenge the traumagenic model.[22] Me: I only have the abstract, but what does the Boysen article [22] have to do with this? To date approximately 250 cases of DID in children have been identified, though the data does not offer unequivocal support for either theory. Me: This makes it sound like only 250 cases of DID have ever been see in children. Me: Again, the conclusion of the article [22 Boysen] does not say any of this. While children have been diagnosed with DID before therapy, several were presented to clinicians by parents with the diagnosis; others were influenced by the appearance of DID in popular culture or due to a diagnosis of psychosis due to hearing voices - a symptom also found in DID. No studies have looked for children with DID in the general population, and the single study that attempted to look for children with DID not already in therapy did so by examining siblings of those already in therapy for DID. An analysis of diagnosis of children reported in scientific publications, 44 case studies of single patients were found to be evenly distributed (i.e. each case study was reported by a different author) but in articles regarding groups of patients, four researchers were responsible for the majority of the reports.[22] Me: Again, the conclusion of the article [22 Boysen] does not say any of this.
Peer Review: When I first read this, I could not imagine how it could possibly be relevant. Then I went back and saw this sentence: "Proponents of the iatrogenic position suggest a small number of clinicians diagnosing a disproportionate number of cases would provide evidence for their position", which shed a bit of light on the matter. There are two problems here: first, we need to hold the reader's hand and guide them through the issues. We cannot just throw data at them and hope that they'll make the connection to the material they've already read, especially since there's no guarantee that the reader will travel through the article from top to bottom.
Peer Review: Second, it needs to be made clear, either explicitly or implicitly, that the author made this connection in his paper. If that's not true, then this material should be removed, as it would be synthesis.
Me: I cannot see where the author said any of this. His conclusion" "Despite continuing research on the related concepts of trauma and dissociation, childhood DID itself appears to be an extremely rare phenomenon that few researchers have studied in depth. Me:(To me this sounds like it's simply something few researchers have studied in depth. Parents abusive enough to cause DID are not going to just hand their children over to be studied and children with DID MUST hide it best they can to survive at home. E. Howell says something to this effect in her 2011 book, so have many others. I can dig out the references if needed.) Nearly all of the research that does exist on childhood DID is from the 1980s and 1990s and does not resolve the ongoing controversies surrounding the disorder
The paragraph mentioned by the peer reviewer from the WP article: Therapist Induced WP paragraph: The iatrogenic position is strongly linked to the False memory syndrome, coined by the False Memory Syndrome Foundation in reaction to memories recovered by a range of controversial therapies whose effectiveness is unproven. Such a memory could be used to make a false allegation of child sexual abuse. There is little consensus between the iatrogenic and traumagenic positions regarding DID.[3] Proponents of the iatrogenic position suggest a small number of clinicians diagnosing a disproportionate number of cases would provide evidence for their position[22] though it has also been claimed that higher rates of diagnosis in specific countries like the United States, may be due to greater awareness of DID. Lower rates in other countries may be due to an artificially low recognition of the diagnosis.[12]
WLU claims to have the actual Boysen study. There is only an abstract online and this is the conclusion.
Despite continuing research on the related concepts of trauma and dissociation, childhood DID itself appears to be an extremely rare phenomenon that few researchers have studied in depth. Nearly all of the research that does exist on childhood DID is from the 1980s and 1990s and does not resolve the ongoing controversies surrounding the disorder.
METHODS: I searched MEDLINE and PsycINFO records for studies published since 1980 on DID/multiple personality disorder in children. For each study I coded information regarding the origin of samples and diagnostic methods.
RESULTS: The review produced a total of 255 cases of childhood DID reported as individual case studies (44) or aggregated into empirical studies (211). Nearly all cases (93%) emerged from samples of children in treatment, and multiple personalities was the presenting problem in 23% of the case studies. Four US research groups accounted for 65% of all 255 cases. Diagnostic methods typically included clinical evaluation based on Diagnostic and Statistical Manual of Mental Disorder criteria, but hypnosis, structured interviews, and multiple raters were rarely used in diagnoses.
What E. Howell has to say about Childhood DID:
1. (pg. xvii)She sites the recent Brand study that reports: 86% of DID patients produces reports of claims of childhood abuse.
2. (pg. xvii) Other causes: "Overwhelming experience in the infant's interpersonal environment that are not caused by parental maltreatment. Parental illness, depression, or problematic attachment styles may be psychically overwhelming and lead to disorganized attachment." Personal comment: This to my mind still is trauma.
What Medscape has to say:
Updated: May 11, 2012 Author: M. Waseem, MD
"The deleterious effects of childhood abusive experiences on growth and development have been well documented and are associated with various later mental health problems. Diagnosis of dissociative identity disorder is not usually made until adulthood, long after the extreme maltreatment thought to engender the condition has occurred. Therefore, although the most common cause of the disorder is agreed to be early, ongoing, extreme physical and/or sexual abuse, accounts of such abuse are usually provided retrospectively by the patient and lack objective verification. Researchers have shown that, in many instances, borderline personality disorder and posttraumatic stress disorder (PTSD) in adulthood may be traced to childhood abuse. The existence of significant dissociative psychopathology related to physical and sexual abuse experienced in childhood was known to clinicians in the last century. However, only recently have modern mental health practitioners begun to appreciate implications of this forgotten linkage.
Clinical and research reports indicate that a history of physical and sexual abuse in childhood is more common among adults who develop major mental illness than previously suspected. Dissociation has also been linked specifically to childhood physical neglect in patients diagnosed with schizophrenia. Various degrees of dissociative disorders are recognized, ranging from passive disengagement and withdrawal from the active environment to multiple personality disorder (MPD), a severe dissociative disorder characterized by disturbances in both identity and memory and best understood as a posttraumatic, adaptive dissociative response to the fear and pain of overwhelming trauma, most commonly abuse. Fully expressed MPD is not often diagnosed as such in the pediatric population; however, other forms of dissociative disorders are not uncommon, as described in this article."
Relevant quotes from another page of same site, see the page for full text: "Children have a much poorer sense of continuity of their behavior and the flow of time than adults do. Symptoms such as the sense of loss of time are not easy for children to discern. Even well into adolescence, children may not recognize loss of time or discontinuity of experience as unusual or abnormal experiences."
"Dissociation reflects disruptions in the integration of memories, perception, and identity into a coherent sense of self. Disruptions in identity may assume the blurring of boundaries between a child's self and fantasy characters."
Dissociation in General - Clinical "A child who is experiencing dissociative symptoms may appear withdrawn, frightened, or uninvolved. Frequently, the child is identified as being "different" from other children, although referring clinicians, caseworkers, foster parents, and teachers are often at a loss to characterize the differences."
"Children with dissociative disorders exhibit a plethora of fluctuating abilities, moods, fears, and anxieties; shifting preferences; inconsistent knowledge; and other evidence of erratic access to information and skills."
"Auditory hallucinations are present in most children and adolescents with dissociative disorder; however, "phobic" hallucinations in severely stressed children and young adolescents do not necessarily indicate an enduring psychotic disorder and may be transient phenomena."