Did

elkpark · Dec 27, 2005

I have been in psych nursing long enough (>20 years) to have lived through the entire controversy (including the change in terminology). I have worked with (a few) clients that I am absolutely convinced actually had DID; there was a well-documented clinical history since childhood on some of these people, there was no other explanation for the behaviors they exhibited, and they were completely sincere about not knowing what was going on with them. I have encountered other clients who were obviously faking or malingering.

IMHO, the disorder is certainly "real" -- but, because it is perceived as more "glamorous" and interesting then many other psych dxs, it is overdiagnosed by some clinicians, and I have worked with many clients who have tried to convince clinicians and others that they have DID rather than plain ol' boring schizophrenia or bipolar disorder because they (sincerely) really don't want to have the disorder they actually do have, see DID as less stigmatizing, and would prefer to have the more glamorous and interesting dx. (Please note that I'm not criticizing them for this; I might well feel exactly the same way if I were in their shoes.)

I remember working with a psychiatrist quite a few years ago (when DID was new and "hot") who was working v. hard to become nationally known as an expert in DID (MPD, as it was known at the time) and, oddly enough, he felt that nearly every client he encountered had DID. At the hospital at which we all worked, he occasionally covered the adolescent unit (on which I was the weekend charge nurse) on weekends, and he would come in on the weekend and dx half the kids on the unit as having DID (y'know, on the basis of one quick chat ...). Then, Monday AM, the regular attending child psychiatrists would have to come in and "fix" that -- it was v. tedious; fortunately, he didn't cover our unit too often.

We did admit one adolescent to the unit who had a well-documented history of DID, and, once he was on the unit and the other kids saw how much attention he got from (some) of the staff (including "Dr. DID," who fell all over him), half the kids on the unit suddenly started "dissociating" (which they had never done before in their extended psychiatric histories). (Many of us staff were joking that we should write up a paper and get famous -- we were the first to discover that DID was contagious!!) Once that particular adolescent was discharged, the "epidemic" of DID subsided quickly ...

Many of the kids were quite humorous in their efforts to convince us that they had multiple personalities -- I will never forget one girl who took hold of her own throat with her left hand and tried to convince me (choking and gasping v. dramatically, sprawled out on the dayroom couch) that her evil alter, "Dragon," had taken control of her left arm (only) and was trying to strangle her, and she needed us to rescue her from "Dragon." (I explained helpfully that it is physically impossible to kill yourself like that -- once she passed out, her left arm would go limp along with the rest of her, "Dragon" or not, and she would be able to breathe again, and refused to get involved in the physical tug-of-war that she wanted (she wanted staff to try to wrestle her left hand away from her throat to "save" her :rolleyes: ). (BTW, this girl decided that she had an "evil alter" named Dragon while the other kid who actually did have DID was on the unit, and while she was reading the Peter Straub horror novel Dragon -- I offered at the time to take any of the staff or docs who were tempted to believe her into her room and show them the novel sitting right there on her nightstand in plain sight. Was this supposed to be coincidence? She had been in and out of psych tx for several years and had never before exhibited any sxs of dissociation (she also had none of the history typical of "real" DID clients), until this other adolescent was admitted to the unit.)

So, 1) yes, I "believe" it's real; 2) yes, I have known clients that I am convinced really had (have) DID and have interacted with their different personalities (although real life is rarely as dramatic as all the movies, etc.); 3) I'm typically pretty dubious about the dx unless/until I have confidence in the diagnosing clinician and the client's history, because the actual disorder is pretty darned rare -- it's much too trendy and has received 'way too much press; everybody and their uncle knows all about it (or, at least, thinks they do) and, as you note, it's easy to fake if you want to.

I have found, over my many years in psych, that, in general, you rarely go wrong by being a little skeptical and waiting to see how things shake out. Best wishes for your studies!

Whispera, MSN, RN · Dec 28, 2005

I've spent time with many patients diagnosed with DID. I believe some really had it too, but not all. The patient who convinced me that it was real was one whose eyes changed color (no, I'm not kidding). Others thought they had it, but that is a disorder in itself, I think. Also, I've found that it seems to be a bit contagious on a hospital unit. At one time the unit I worked on had several patients diagnosed with DID. Before long another patient "had" it. It's all very interesting and confusing!

MedicalZebra · Dec 28, 2005

I was diagnosed with it after a kidney transplant-- high doses of prednisone seemed to be the cause.

My eyes changed color (from light brown to black) and I also had a change in blood pressure-- my normal pressure was 150/100 but when my 'guest personality' (Soldier Guy) was around, it went down to 120/70. I wore a cammo jacket everywhere, and started writing with my left hand. All of these effects went away shortly after the kidney rejected.

Thunderwolf, MSN, RN · Dec 28, 2005

I whole heartedly echo what Elkpark has posted. And it is RARE. It is also a Borderline PD play ground as well...so watch out. In my whole ten years in psych (outpt counselor and nurse and inpt nurse), I can state honestly that I have met only ONE that genuinely met the criteria for DID/MPD........ONE. I also am very familiar of a particular doc who tried to make his claim to fame using this dx as his spring board in a nearby city many years ago, diagnosing everyone with it in sight. Shame....because purposeful misdiagnosing discredits the doc professionally, bilks insurance fraudulently, and harms the patient. No, it is a very rare condition.

spaniel · Dec 28, 2005

Hi- I've been working psych on and off since oh about l969. Within the spectrum of dissociation disorders, I have not met one multiple nor have I met someone with fugue. But I have met a few with primary depersonalization disorder.

kadokin, ASN, RN · Jan 1, 2006

I've spent time with many patients diagnosed with DID. I believe some really had it too, but not all. The patient who convinced me that it was real was one whose eyes changed color (no, I'm not kidding). Others thought they had it, but that is a disorder in itself, I think. Also, I've found that it seems to be a bit contagious on a hospital unit. At one time the unit I worked on had several patients diagnosed with DID. Before long another patient "had" it. It's all very interesting and confusing!

His "eyes changed color"? Are you sure? Was he maybe one of those people whose eyes change color if their shirt or the paint on the wall behind them is a different color? Did YOU notice his eyes changing color on their own or did HE point it out to you?

Ever the skeptic,

Kadokin

kadokin, ASN, RN · Jan 1, 2006

Hi- I've been working psych on and off since oh about l969. Within the spectrum of dissociation disorders, I have not met one multiple nor have I met someone with fugue. But I have met a few with primary depersonalization disorder.

Although I am a psych nurse, I don't deal w/a lot of axis II stuff. I work in an inpatient acute care, and while we SEE axis II, we rarely bother to dx or treat it, insurance co's don't pay for that in inpt. acute care, ya know. Anyway, what is the difference between DID and PDD.

Curious,

Kadokin

kadokin, ASN, RN · Jan 1, 2006

I was diagnosed with it after a kidney transplant-- high doses of prednisone seemed to be the cause.
My eyes changed color (from light brown to black) and I also had a change in blood pressure-- my normal pressure was 150/100 but when my 'guest personality' (Soldier Guy) was around, it went down to 120/70. I wore a cammo jacket everywhere, and started writing with my left hand. All of these effects went away shortly after the kidney rejected.

WHOA! That is uncanny. We just admitted a pt today in a severe psychotic state that is a kidney transplant pt. Tell me more. It could help us take care of this individual. Thanks! :nurse: