Chapter 11. Basic Attitude for the Treatment of Dissociative Disorder (3)

The way DID patients manifest themselves --- through misunderstanding and misdiagnosis.
DID patients might have been misunderstood and misconstrued before they are finally recognized as having this condition. Although Japanese psychiatrists are really commendable for their diagnostic skills as far as psychoses and mood disorders are concerned, they are basically still unfamiliar with the concept of dissociation. Unfortunately, patient’s visit with a psychiatrist does not necessarily result in a step closer to a proper diagnosis as far as dissociative disorder is concerned.
One young female patient once told me about her experience as follows. Prior to her contact with mental health professionals, she was wondering how to understand her own dissociative experiences. Based on what she read in the books and internet, she came to a conclusion that she might have a condition of DID. She then decided to visit a psychiatrist to see if it is true. However her psychiatrist told her “any patient who comes in wondering if she has DID, that diagnosis needs to be questioned.” She then was given a medium dose of antipsychotic medication and was sent home.
Another patient with DID told me that when she visited a psychiatrist for the first time, she was told “There is no DID without the history of child abuse. Therefore in your case, you don’t have real DID.” And she was refused further treatment.
Although there could be some exaggeration and distortion, their account sounds largely plausible and therefore, very saddening. Richard Kluft once reported that 49% of DID patients have ever been misdiagnosed with schizophrenia (Kluft, 1987), and similar situation appears to be seen in our country.
Kluft. R. 1987. First-Rank Symptoms as a Diagnostic Clue to Multiple Personality Disorder Am J Psychiatry 144:293-298.
There is one thing that many psychologists and psychiatric residents tell after their initial experience of taking a history of DID patients: they feel overwhelmed by the complexity of the history and clinical course of the patient. It is true that their clinical manifestations are usually very unique and complex. It would become even more confusing if different identities show up and tell their stories. If the original information of the host personality obtained is compared to a two-dimensional world, the total information including other identities might feel like in a three- or four-dimensional world.