Growing Not Dwindling: International Research on the Worldwide Phenomenon of Dissociative Disorders

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To the EditorIn the December 2012 issue of the Journal, Joel Paris, MD, wrote an article about the current status of dissociative identity disorder (DID) and the dissociative disorder field in general. He suggests that DID is merely a “fad” and that there is no credible evidence to connect traumatic experiences with the development of DID.We refute several of the claims made by Dr Paris.Our biggest concern as non–North American researchers is that Dr Paris does not reference a single international study related to dissociative disorders and DID, despite the considerable and increasing empirical literature from around the world. His speculation that DID is not diagnosed outside clinics that specialize in treating dissociation is not consistent with current data. DID and dissociative disorders have been reliably found in general psychiatric hospitals; psychiatric emergency departments; and private practices in countries including England, the Netherlands, Turkey, Puerto Rico, Northern Ireland, Germany, Finland, China, and Australia, among many others (e.g., Dorahy et al., 2006; Leonard et al., 2005; Lewis-Fernández et al., 2007; Lipsanen et al., 2004; Martínez-Taboas, 2005; Martínez-Taboas et al., 1995, 2006; Middleton and Butler, 1998; Rodewald et al., 2011; Sar, 2006; Sar et al., 2007b, 1996; Tutkun et al., 1998).Much of the international research, using sophisticated epidemiological and clinical research methods, has replicated dozens of times the finding that dissociative processes and disorders (including DID) can be reliably detected in a wide spectrum of different societies. Epidemiological general population studies indicate that 1.1% to 1.5% meet diagnostic criteria for DID; and 8.6% to 18.3%, for any DSM-IV dissociative disorder (Johnson et al., 2006; Sar et al., 2007a). The international literature on DID and dissociative disorders has been widely published in mainstream journals of psychiatry and psychopathology and is inconsistent with Dr Paris’s conclusions.Similarly, with regard to treatment, almost 300 patients from 18 countries participated in the most recent prospective treatment study of DID and a closely related disorder, dissociative disorder not otherwise specified (Brand et al., 2012). Moreover, the authorship of the 2011 International Society for the Study of Trauma and Dissociation guidelines for the treatment of DID included clinicians from North America, Europe, the Middle East, and Australasia.Dr Paris also opines that there is only a “weak link” between child abuse and psychopathology, quoting an article published 17 years ago. Current research illustrates a very different picture. Persons with early abusive experiences demonstrate increased illnesses (Green and Kimerling, 2004), impaired work functioning (Lee and Tolman, 2006), serious interpersonal difficulties (Van der Kolk and d’Andrea, 2010), and a high risk for traumatic revictimization (Rich et al., 2004). The Adverse Childhood Experiences Study, an American epidemiological study, has provided retrospective and prospective data from more than 17,000 individuals on the effects of traumatic experiences during the first 18 years of life. This large study demonstrated the enduring, strongly proportionate, and frequently profound relationship between adverse childhood experiences and emotional states, health risks, disease burdens, sexual behavior, disability, and health care costs, even decades later (Felitti and Anda, 2010). Specifically, child sexual abuse (CSA) has been related in various epidemiological studies to the subsequent onset of a variety of psychiatric disorders. For example, Molnar et al. (2001), using data from the National Comorbidity Survey, found that CSA was associated with 14 psychiatric disorders among women and 5 among men, even after controlling for other childhood adversities. Dinwiddie et al.

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