Department of Psychology Towson University, MDThe Trauma Disorders Program Sheppard Pratt Health System Baltimore, MD Department of Psychiatry University of Maryland School of Medicine BaltimoreDepartment of Psychiatry and Behavioral Sciences Stanford University School of Medicine CA
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To the EditorWe write to record our objections to both the form and the content of Dr Joel Paris’s recent article entitled The Rise and Fall of Dissociative Identity Disorder (Paris, 2012). His claim that dissociative identity disorder (DID) is a “medical fad” is simply wrong, and he provides no substantive evidence to support his claim. From the mistaken identification of Pierre Janet as a psychiatrist in the first line (Janet was the most famous psychologist of his day), it is replete with errors, false claims, and lack of scholarship and just plainly ignores the published literature.Dr Paris provided a highly biased article that is based on opinion rather than on science. His review of the literature is extremely selective. Of 48 references, Dr Paris cites exactly 7 peer-reviewed articles published from 2000 onward (7/48 references equals 14%) and only 8 peer-reviewed, data-driven articles from before 2000 (8/48 equals 16%). Rather than relying on the recent peer-reviewed, scientific literature, Paris relied almost entirely on the non–peer-reviewed books, including a popular press book written by a journalist whose methods and conclusions have been strongly challenged. He claims that interest and research in DID have waned, yet he fails to cite the multitude of studies that have been conducted about it. In fact, Dalenberg et al. (2007) documented evidence of the exact opposite pattern described by Paris: “A search of the PILOTS database offered by the National Center for Posttraumatic Stress Disorder for articles on dissociation reveals 64 studies in 1985–1989, 236 published in 1990–1994, 426 published in 1995–1999 and 477 in the last 5-year block (2000–2004)” (p. 401).Dr Paris seems unaware of the depth and the breadth of research about dissociation yet made sweeping generalizations about it. For example, he fails to review the neurobiological and clinical research that has led to the addition of a dissociative subtype of posttraumatic stress disorder (PTSD) in the DSM-5. He fails to cite cutting-edge research on dissociation including a recent study by 2012) in Biological Psychiatry that found evidence of the dissociative subtype of PTSD in about 14.4% of 25,018 individuals in a World Health Organization sample involving 16 countries. The dissociative subtype was associated with male sex, a history of high exposure to previous traumatic events and childhood adversities, subsequent onset of PTSD in childhood, histories of separation anxiety disorder and specific phobia, severe role impairment, and suicidality. Dr Paris fails to cite a review article in 2010 in the American Journal of Psychiatry identifying a neurobiological and psychophysiological profile of the dissociative subtype of PTSD (Lanius et al., 2010). These individuals respond to traumatic scripts with hyperfrontality and limbic inhibition on functional magnetic resonance imaging, in contrast to those with the hyperarousal type, who have hypofrontality and limbic activation. In addition, he fails to cite a variety of neurobiological and psychophysiological studies of DID documenting similar brain morphology abnormalities in patients with DID to those of other traumatized patients (Reinders et al., 2006; Vermetten et al., 2006). Despite failing to review this and other relevant research, Dr Paris made the claim that “Neither the theory behind the diagnosis nor the methods of treatment are consistent with the current preference for biological theories” (p. 1078). Furthermore, he fails to cite any research that has been done by researchers outside North America. For example, Vedat Sar, MD, in Turkey has published more than 70 articles and chapters on dissociative disorders and trauma (http://vedatsar.com/index_2.htm), but Dr Paris failed to mention a single one.