User:Vanished user 54564fd56f45f4dsa5f4sf5/sandbox

Work in progress

By WLU - Responding to your substantive point, it is predicated on the assertion that your opinions represent the mainstream consensus of experts on DID. I do not believe you have backed up this assertion, and in fact the number and publication views of those who explicitly disbelieve the traumagenic hypothesis suggests, as I have said before, that either the traumagenic hypothesis is not the mainstream view, or that there is a substantial minority of scholars publishing their doubts in peer reviewed journals - and therefore discussion of their points on this page is perfectly legitimate.

WLU presents two questions from what I can see in his paragraph above:

* What is the mainstream consensus re: traumagenisis?

Answer: Where does the consensus model come from? It has to be from the American Psychiatric Association (who develops and publishes the DSM, of course), and the research specialists in the field of dissociative disorders. Where else would you get it? 3 MODELS are pdf file that are considered by the APA and all 3 models should be presented on the WP DID page.

* How much weight is to be given to dissenting views?

Answer: The dissenting view would be the SCM. The APA gives no weight to the SGM. The world's top researchers in DID report that there is NO actual research for the sociocognitive method (SCM). With no research support, any alternative ideas are just speculations.

---- If unfamiliar with WP rules see the bottom of the page -----

In depth information is presented below if the above is not sufficient:

Below are direct quotes from pages 116 to 172 from the Journal of Trauma & Dissociation, 12:115–187, 2011 Copyright© International Society for the Study of Trauma and Dissociation ISSN: 1529-9732 print/1529-9740 online DOI: 10.1080/15299732.2011.537247

"They consistently provide evidence that DID is a valid cross-cultural diagnosis that has validity comparable to or exceeding that of other accepted psychiatric diagnoses" (p.116)

"The current revision of the Guidelines focuses specifically on the treatment of dissociative identity disorder (DID) and those forms of dissociative disorder not otherwise specified (DDNOS) that are similar to DID. It is intended as a practical guide to the management of adult patients and represents a synthesis of current scientific knowledge and informed clinical practice." (p.116)

"Accurate clinical diagnosis affords early and appropriate treatment for the DD. The difficulties in diagnosing DID result primarily from lack of education among clinicians about dissociation, dissociative disorders, and the effects of psychological trauma, as well as from clinician bias. This leads to limited clinical suspicion about dissociative disorders and misconceptions about their clinical presentation." (p.117)

"Moreover, because most clinicians receive little or no training in dissociation and DID, they have difficulty recognizing the signs and symptoms of DID even when they occur spontaneously." (p.118)

"The DID patient is a single person who experiences himself or herself as having separate alternate identities that have relative psychological autonomy from one another. At various times, these subjective identities may take executive control of the person’s body and behavior and/or inﬂuence his or her experience and behavior from “within.” Taken together, all of the alternate identities make up the identity or personality of the human being with DID." (p.120)

Note: We are using "personality state", perhaps we should use identity state instead. "Many terms have been developed to describe the DID patient’s subjective sense of self-states or identities. These include personality, personality state, self-state, disaggregate self-state, alter, alter personality, alternate identity, part, part of the mind, part of the self, dissociative part of the personality, and entity, among others (see Van der Hart (this would be ANP and EP) & Dorahy, 2009). Because the DSM–IV–TR (American Psychiatric Association, 2000a) uses the term alternate identity, this term is used in the Guidelines for consistency." (p.121)

First Etiological Model presented

"...alternate identities result from the inability of many traumatized children to develop a uniﬁed sense of self that is maintained across various behavioral states, particularly if the traumatic exposure ﬁrst occurs before the age of 5. These difficulties often occur in the context of relational or attachment disruption that may precede and set the stage for abuse and the development of dissociative coping." "Fragmentation and encapsulation of traumatic experiences may serve to protect relationships with important (though inadequate or abusive) caregivers and allow for more normal maturation in other developmental areas, such as intellectual, interpersonal, and artistic endeavors. In this way, early life dissociation may serve as a type of developmental resiliency factor despite the severe psychiatric disturbances that characterize DID patients." "Severe and prolonged traumatic experiences can lead to the development of discrete, personified behavioral states (i.e., rudimentary alternate identities) in the child, which has the effect of encapsulating intolerable traumatic memories, affects, sensations, beliefs, or behaviors and mitigating their effects on the child’s overall development. "...disturbed caregiver–child attachments and parenting further disrupt the child’s ability to integrate experiences" Secondary structuring of these discrete behavioral states occurs over time through a variety of developmental and symbolic mechanisms, resulting in the characteristics of the specific alternate identities. The identities may develop in number, complexity, and sense of separateness as the child proceeds through latency, adolescence, and adulthood." (p.122)

Another etiological model

...posits that the development of DID requires the presence of four factors: (a) the capacity for dissociation; (b) experiences that overwhelm the child’s nondissociative coping capacity; (c)secondary structuring of DID alternate identities with individualized characteristics such as names, ages, genders; and (d) a lack of soothing and restorative experiences, which renders the child isolated or abandoned and needing to ﬁnd his or her own ways of moderating distress. The secondary structuring of the alternate identities may differ widely from patient to patient. Factors that may foster the development of highly elaborate systems of identities are multiple traumas, multiple perpetrators, significant narcissistic investment in the nature and attributes of the alternate identities, high levels of creativity and intelligence, and extreme withdrawal into fantasy, among others." (p.122-123)

Structural Dissociation of the Personality

"This theory suggests that dissociation results from a basic failure to integrate systems of ideas and functions of the personality. Following exposure to potentially traumatizing events, the personality as a whole system can become divided into an “apparently normal part of the personality” dedicated to daily functioning and an “emotional part of the personality” dedicated to defense. Defense in this context is related to psychobiological functions of survival in response to life threat, such as ﬁght/ﬂight, not to the psychodynamic notion of defense. It is hypothesized that chronic traumatization and/or neglect can lead to secondary structural dissociation and the emergence of additional emotional parts of the personality." (p.123)

"In short, these developmental models posit that DID does not arise from a previously mature, uniﬁed mind or “core personality” that becomes shattered or fractured. Rather, DID results from a failure of normal developmental integration caused by overwhelming experiences and disturbed caregiver–child interactions (including neglect and the failure to respond) during critical early developmental periods. This, in turn, leads some traumatized children to develop relatively discrete, personified behavioral states that ultimately evolve into the DID alternate identities. (p.123)

Sociocognitive (SCM)

The expert consensus reports: ..."there is no actual research that shows that the complex phenomenology of DID can be created, let alone sustained over time, by suggestion, contagion, or hypnosis." (p.124)

----------------------------- End of Etiology --------------------------------------

Beyond page 124 of the paper:

I can go into more detail if we have disagreement about anything below this line, as it is I kept the summary of the guidelines brief beyond etiology since this seems to be the primary cause of debate on the DID WP page.

Diagnostic Interviewing "A careful clinical interview and thoughtful differential diagnosis can usually lead to the correct diagnosis of DID." (p.124)

Differential Diagnosis and Misdiagnosis of DID "It is important that clinicians appreciate the similarities and differences between the symptoms of dissociative disorders and other frequently encountered disorders." (p.128)

TREATMENT GOALS AND OUTCOME "Treatment should move the patient toward better integrated functioning whenever possible. In the service of gradual integration, the therapist may, at times, acknowledge that the patient experiences the alternate identities as if they were separate. Nevertheless, a fundamental tenet of the psychotherapy of patients with DID is to bring about an increased degree of communication and coordination among the identities. In most DID patients, each identity seems to have its “own” ﬁrst-person perspective and sense of its “own” self, as well as a perspective of other parts as being “not self.” " "Helping the identities to be aware of one another as legitimate parts of the self and to negotiate and resolve their conﬂicts is at the very core of the therapeutic process." (p.132)

Integration or Fusion "A desirable treatment outcome is a workable form of integration or harmony among alternate identities. Terms such as integration and fusion are sometimes used in a confusing way. Integration is a broad, longitudinal process referring to all work on dissociated mental processes throughout treatment." (p.133)

PHASE-ORIENTED TREATMENT APPROACH "Over the past two decades, the consensus of experts is that complex trauma-related disorders—including DID—are most appropriately treated in sequenced stages." (p.135)

1. Establishing safety, stabilization, and symptom reduction; 2. Confronting, working through, and integrating traumatic memories; and 3. Identity integration and rehabilitation. (p. 135)

I could care less about memory accuracy and hope others with DID feel the same, but it is still a touchy subject with some editors at WP so here is what the expert consensus says:

Validity of Patients’ Memories of Child Abuse "DID patients frequently describe a history of pervasive abuse beginning in childhood. Although many enter therapy remembering some abusive childhood experiences, most also recover additional previously unrecalled memories of abuse and/or additional details of partially recalled memories. Such memory recall occurs both within and outside of therapy sessions. Newly recalled trauma memories frequently precede or precipitate the patient’s entry into psychotherapy Memories that are “recovered” (i.e., forgotten and subsequently recalled) can often be corroborated and are no more likely to be confabulated than memories always recalled." "... reports have all concluded that it is possible for accurate memories of abuse to have been forgotten for a long time, only to be remembered much later in life. They also indicate that it is possible that some people may construct pseudomemories of abuse and that therapists cannot know the extent to which someone’s memories are accurate in the absence of external corroboration—which may be difficult or impossible to obtain, especially given the passage of time. As with all memories, recall of child abuse experiences may at times mix recollections of actual events with fantasy, confabulated details, abusers’ rationalizations of the events, or condensations of several events." "Therapy does not benefit from clinicians automatically telling patients either that their memories are likely to be false or that they are accurate and must be believed. The therapist is not an investigator, and there are ethical, boundary, and countertransference considerations related to his or her role in attempting to prove or disprove the patient’s trauma history. Moreover, therapists must be careful, whatever their theoretical persuasion, not to lose sight of the patient’s vulnerability to accommodate in some way to the therapist’s authority in the psychotherapy relationship, the production of memories being one of them. A respectful neutral stance on the therapist’s part, combined with care to avoid suggestive and leading interview techniques, along with ongoing discussion and education about the nature of memory seems to allow patients the greatest freedom to evaluate the veracity and import of their memories." (p.166-167)

CONCLUSIONS " The information in these Guidelines represents current and evolving principles that reﬂect current scientific knowledge and clinical consensus developed over the past 30 years with regard to the diagnosis and treatment of DID. Given that ongoing research on the diagnosis and treatment of dissociative disorders and other related conditions such as PTSD will lead to further developments in the ﬁeld, clinicians are advised to continue to consult the published literature to keep up with important new information. It is strongly recommended that therapists treating DID and other dissociative disorders have proper training in their diagnosis and treatment, for example through programs available through the ISSTD." (p.172)

2011 REVISED Adult Guidelines Guidelines for Treating Dissociative Identity Disorder in Adults, third revision. Journal of Trauma & Dissociation. 12:2, 2011 guidelines written by top people in the field of DID: Chu, Dell, van der Hart, Cardena, Barach, Somer, Loewenstein, Brand, Golston, Courtois, Bowman, Classen, Dorahy, Sar, Gelinas, Fine, Paulsen, Kluft, Dalenbert, Jacobson-Ley, Nijenhuis, Boon, Chefetz, Middleton, Ross, Howell, Goodwin, Coons, Frankel, Steele, Gold, Gast, Young and Twomby.with page numbers:

1. Members of the Standards of Practice Committee were Peter M. Barach, PhD (Chair), Elizabeth S. Bowman, MD, Catherine G. Fine, PhD, George Ganaway, MD, Jean Goodwin, MD, Sally Hill, PhD, Richard P. Kluft, MD, Richard J. Loewenstein, MD, Rosalinda O’Neill, MA, Jean Olson, MSN, Joanne Parks, MD, Gary Peterson, MD, and Moshe Torem, MD.

2. Members of the 2005 Guidelines Revision Task Force included James A. Chu, MD (Chair), Richard Loewenstein, MD, Paul F. Dell, PhD, Peter M. Barach, PhD, Eli Somer, PhD, Richard P. Kluft, MD, Denise J. Gelinas, PhD, Onno van der Hart, PhD, Constance J. Dalenberg, PhD, Ellert R. S. Nijenhuis, PhD, Elizabeth S. Bowman, MD, Suzette Boon, PhD, Jean Goodwin, MD, Mindy Jacobson, ATR, Colin A. Ross, MD, Vedat ¸Sar, MD, Catherine G. Fine, PhD, A. Steven Frankel, PhD, Philip M. Coons, MD, Christine A. Courtois, PhD, Steven N. Gold, PhD, and Elizabeth Howell, PhD.

3. Members of the 2010 Guidelines Task Force included James A. Chu, MD (Chair), Paul F. Dell, PhD, Onno van der Hart, PhD, Etzel Cardeña, PhD, Peter M. Barach, PhD, Eli Somer, PhD, Richard J. Loewenstein, MD, Bethany Brand, PhD, Joan C. Golston, DCSW, LICSW, Christine A. Courtois, PhD, Elizabeth S. Bowman, MD, Catherine Classen, PhD, Martin Dorahy, PhD, Vedat ¸Sar, MD, Denise J. Gelinas, PhD, Catherine G. Fine, PhD, Sandra Paulsen, PhD, Richard P. Kluft, MD, Constance J. Dalenberg, PhD, Mindy Jacobson-Levy, ATR, Ellert R. S. Nijenhuis, PhD, Suzette Boon, PhD, Richard A. Chefetz, MD, Warwick Middleton, MD, Colin A. Ross, MD, Elizabeth Howell, PhD, Jean Goodwin, MD, Philip M. Coons, MD, A. Steven Frankel, PhD, Kathy Steele, MN, CS, Steven N. Gold, PhD, Ursula Gast, MD, Linda M. Young, MD, and Joanne Twombly, MSW, LICSW.

---- Wikipedia rules and guidelines that apply to this problem on the DID page -----

There is NO empirical support for the SGM. The mainstream expert consensus does not agree with the minority/fringe POV of SCM at all! Not even an itty bitty bit! See p.124 and all information presented above.

It is the job of Wikipedia to summarize the consensus model of any field.[rule link] Answer: The ISSTD has done that for us in their guidelines 2011 REVIEW paper commissioned by the DSM-5 work group, and the current edition of the DSM. In NONE of these is there any mention of the SGM as credible in anyway. There is no other consensus. This document [link to pdf] simply has no competition. A significant number of the people authoring these guidelines are involved in the DSM-5 anxiety, (see the bottom of this page for names) obsessive-compulsive spectrum, posttraumatic, and the dissociative disorders work group or the research review commissioned by this work group. In NONE of these is there any mention of the SGM as credible in anyway.

Minority/fringe opinions are of no importance at Wikipedia.[rule link]

Fringe opinions simply are not competitors with the professional consensus. [rule link]

Neutrality also means giving due weight to the different points of view. If the broad scientific community has one set of opinions – then the minority opinion should not be shown. [rule link]

[Note to self: Read all rules and see if others apply]