Wikipedia:Peer review/Dissociative identity disorder/archive1

Dissociative identity disorder

I've listed this article for peer review because I want to be sure about the balance in an article about a medical diagnosis over which there is controversy and disagreement. The article is presented as two "sides" when the addition of more nuance may help.

Really need more "eyes" on this article. Any feedback is welcomed. (I'll look for an article to peer review myself.)

Thanks, MathewTownsend (talk) 23:25, 28 July 2012 (UTC)

Comments from Cryptic C62

• "accompanied by the inability to recall personal information beyond what is expected through normal forgetfulness." Is this an allusion to the fact that one personality does not have access to information that is learned while the other personality is in control? If so, this should be made more clear.

That's a point of debate within the literature actually, and the wording is carefully taken from the DSM. The DSM itself doesn't clarify beyond this, it takes a purely descriptive rather than etiological (?) or pathophysiological (?) approach. See pages 526 and 529 of the DSM. This is (hopefully) clarified later in that section with the statement "Identities may be unaware of each other and compartmentalize knowledge and memories" but that's two different sources (DSM and Merck respectively). WLU (t) (c) Wikipedia's rules:^simple/_complex 15:50, 14 August 2012 (UTC)

• "The diagnosis excludes symptoms caused by alcohol, drugs or medications and other medical conditions such as complex partial seizures and normal fantasy play in children." This sentence belongs under Diagnosis, not under Signs and Symptoms.

Done. WLU (t) (c) Wikipedia's rules:^simple/_complex 15:50, 14 August 2012 (UTC)

• "degree of symptom severity and level of daily functioning varies widely from severely impaired to normal to "highly effective"." First of all, "varies" should be "vary", as there are two things that are varying here: the degree symptom severity, and the level of daily functioning. Secondly, the list at the end of the sentence only makes sense when used to describe daily functioning. It does not make any sense to describe the degree of symptom severity as "highly effective".

Done, removed symptoms since they are basically included in both clinical presentation and level of daily functioning. WLU (t) (c) Wikipedia's rules:^simple/_complex 15:50, 14 August 2012 (UTC)

• "The majority of patients with DID report a history of abuse, mostly sexual but also physical abuse during their childhood" The word order here is a bit wonky. Here's an idea: "The majority of patients with DID report a history of abuse in their childhood, particularly sexual or physical."

Done, slightly different wording chosen - "The majority of patients with DID report childhood sexual and/or physical abuse..." WLU (t) (c) Wikipedia's rules:^simple/_complex 15:50, 14 August 2012 (UTC)

• "Individuals with DID may be reluctant to share symptoms" The phrase "share symptoms" doesn't make sense in this context. I think "discuss symptoms" would be a better phrasing.

Done. WLU (t) (c) Wikipedia's rules:^simple/_complex 15:50, 14 August 2012 (UTC)

• The Signs and symptoms section should discuss what is the typical number of distinct personalities for a DID patient. 2? 3? 8?

Varies according to year and source and is again a point of controversy, Hersen, 2011 gives an average of about 16, plus some nuance. Appears to be a bit muddled, with the outliers driving up the average (16) while the mode is lower (most report <10). WLU (t) (c) Wikipedia's rules:^simple/_complex 15:50, 14 August 2012 (UTC)

Also, there is only one personality, with alternate identities. MathewTownsend (talk) 15:55, 14 August 2012 (UTC)

Ugh, I would characterize it as "fraught with debate". I could be wrong, my impression was there's still fundamental terms that are undefined, and "identity" and "personality" are both exemplars of this. Is it different people in one brain? Exaggerations of different traits within one identity? I don't know if these things are settled - as in I genuinely don't know, it could be settled and I haven't read that particular source yet. WLU (t) (c) Wikipedia's rules:^simple/_complex 16:14, 14 August 2012 (UTC)

I think it's fairly settled that there is "one" person with "dissociated" (whatever you want to call them). Are there claims otherwise? Isn't the question rather what are these "alternative identities" and, more in contention, from whence do they arise? I think DSM assume one personality. (Of course, it all depends on how "personality" is defined - which isn't settled, just like there is no definition for "dissociation". MathewTownsend (talk) 16:26, 14 August 2012 (UTC)

DSM actually says "distinct identities or personality states" :) Isn't it enough to make you bite your tongue off??!?!?! And it's an issue you can either see as a pedantic tangent, or crucial to the entire concept! One of many frustrating areas in the diagnosis. WLU (t) (c) Wikipedia's rules:^simple/_complex 16:43, 14 August 2012 (UTC)

• "82% of DID patients are diagnosed with at least one other DSM Axis I diagnosis in their lifetime" So... they're diagnosed with a diagnosis? I suggest replacing "diagnosis" with "disorder".

Done. WLU (t) (c) Wikipedia's rules:^simple/_complex 15:50, 14 August 2012 (UTC)

• "Common Axis I co-morbidities include ... posttraumatic stress disorder (PTSD) (up to 80%)" I'm curious: does this mean that 80% of DID patients also have PTSD? Or 80% of PTSD patients also have DID? The two are quite different, and it's not clear which is the correct interpretation.

Done, though not in the way suggested. Galbraith, 2000 didn't actually contain these figures so I'm not sure where they came from. I removed all of the specific percentages and included a much vaguer "these were comorbid" statement. WLU (t) (c) Wikipedia's rules:^simple/_complex 15:50, 14 August 2012 (UTC)

• I'm seeing some instances of "DSM Axis" and some of "DSM axis". The capitalization should be consistent.

Done. WLU (t) (c) Wikipedia's rules:^simple/_complex 15:50, 14 August 2012 (UTC)

• The first paragraph of Causes introduces quite a few terms that should be wikilinked.

Reading through it, I don't know what terms you are referring to, nothing jumps out at me. Could you expand? WLU (t) (c) Wikipedia's rules:^simple/_complex 15:50, 14 August 2012 (UTC)

If you find these comments helpful, leave a note here or my talk page, and I'll review more of the article. Cheers! --Cryptic C62 · Talk 21:01, 5 August 2012 (UTC)