Exact mechanism of the switching in dissociation on the brain level is largely unknown, except for what we can speculate as I have already discussed in the chapter 9. As far as I know, there is no neurophysiological model of dissociation that majority of specialists have agreed upon, despite rapid development of recent neuroscientific researches.
As for epidemiological studies and treatment theories, our country (Japan) lags far behind North American and European countries and is still on the stage of passively importing them from these countries. Among Japanese clinicians and researchers, many of them are interested in the development of studies abroad, but that does not mean that they can apply their knowledge clinically.
In psychiatry, this type of discrepancy is often seen, especially American made notions and methods. Other examples include therapeutic methods of EMDR, DBT, etc. that Japanese clinicians become intellectually familiar with, without ever practicing them clinically. While dissociative disorder is more recognized than before by Japanese clinicians on an intellectual level, and perhaps they can make a tentative diagnosis if they face dissociative patients for the first time in their offices, but they are at loss when it comes to their handling them clinically. However, it should be considered as a step forward anyway compared to a couple of decades ago where the clinical entity of dissociative disorder itself was still doubted or scoffed off by mental health professionals.
Based on my experiences with more than fifty Japanese DID patients, it appears that they have a fairly common profile and it is roughly comparable to that of American DID cases that I saw. Once Japanese clinicians have clinical experiences of certain number of DID cases, they usually become quite skillful in diagnosing DID and telling them apart from schizophrenic and other confusing cases, and above-mentioned discrepancy is resolved.
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