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 assumes one personality. (Of course, it all depends on how "personality" is defined - which isn't settled apparently, just like there is no definition for "dissociation". MathewTownsend (talk) 16:26, 14 August 2012 (UTC)

I completely and totally agree with Mathew here.~ty (talk) 17:28, 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)

No, because in psychological assessment that's a term commonly used, like ego states, and I have a feel for what it means. But I understand that others don't. DSM wording I understand. MathewTownsend (talk) 17:02, 14 August 2012 (UTC)

I again agree with Mathew.~ty (talk) 17:28, 14 August 2012 (UTC)

To turn this on its head, what are the sources that the issue is settled and that "personality states" is the accepted, universally appropriate term to use? Ideally I'd like to integrate sources from both sides if they exist. WLU (t) (c) Wikipedia's rules:^simple/_complex 19:56, 14 August 2012 (UTC)

There are many terms that mean the same thing. Ego state, part of the personality, personality state. Also terms that describe a personality state that is dissociated, alter, altered state, dissociated part of the personality. I agree with Mathew that using the term "personality state" which is used in the DSM reduces confusion. The DSM is the source.~ty (talk) 20:06, 14 August 2012 (UTC)

I don't agree that these many terms mean the same thing. "Ego state", originally Freudian and used by ego psychologists, is not (necessarily) pathological, is not dissociated, and is not used by the DSM in reference to DID and I haven't run across its use in any of the DID articles. However "alter" or "dissociated part of the personality" is a term used by some to mean pathological "identities". "Personality states" and "identities" are terms used by DSM-IV. Since the American Psychiatric Association (APA)) wrote the DSM and defined DID, this gives the terms it uses legitimacy that other terms do not have. "Altered state" could mean being drunk or high for example and is not necessarily pathological in my mind in the diagnostic sense. "Parts of the personality" is not a "term" but rather a phrase; I don't know what it means, whether pathological or not. It would depend on the context. MathewTownsend (talk) 20:52, 14 August 2012 (UTC)

We are saying the same thing Mathew and at least I was trying to say what you did say. I have no disagreement with this at all, and appreciate your professional description. Thank you.~ty (talk) 21:03, 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.

done.~ty (talk) 20:20, 14 August 2012 (UTC)

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)

• "To date approximately 250 cases of DID in children have been identified" To what date? See WP:ASOF.
• I am of the opinion that, whenever possible, every section should refer to more than one source. In children, which covers a somewhat contentious topic, only references Boysen 2011.

I've addressed both of these I believe ({{As of}} and the addition of another citation to the section on children). Not sure if this page is being updated or not, feel free to remove this comment if need be. WLU (t) (c) Wikipedia's rules:^simple/_complex 02:35, 18 August 2012 (UTC)

• "An analysis of diagnosis of children reported in scientific publications, 44 case studies of single patients were found to be evenly distributed (i.e. each case study was reported by a different author) but in articles regarding groups of patients, four researchers were responsible for the majority of the reports." When I first read this, I could not imagine how it could possibly be relevant. Then I went back and saw this sentence: "Proponents of the iatrogenic position suggest a small number of clinicians diagnosing a disproportionate number of cases would provide evidence for their position", which shed a bit of light on the matter. There are two problems here: first, we need to hold the reader's hand and guide them through the issues. We cannot just throw data at them and hope that they'll make the connection to the material they've already read, especially since there's no guarantee that the reader will travel through the article from top to bottom. Second, it needs to be made clear, either explicitly or implicitly, that the author made this connection in his paper. If that's not true, then this material should be removed, as it would be synthesis.

Reply: Looks like Boysen looked at published studies in the 1980's and 1990's. Boysen's exact words: "Nearly all of the research that does exist on childhood DID is from the 1980s and 1990s and does not resolve the ongoing controversies surrounding the disorder." So much more is now known about diagnosis and symptoms than at those times.

Reply: I could not agree more about having 2 references.

Reply: I cannot see where the author said much of the information stated in the WP article. His conclusion" "Despite continuing research on the related concepts of trauma and dissociation, childhood DID itself appears to be an extremely rare phenomenon that few researchers have studied in depth.

Reply to Peer Review on Childhood DID: Working on the issue here, where I added more info if needed.

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)

• Your comments are very helpful. Please continue! MathewTownsend (talk) 15:43, 15 August 2012 (UTC)

Yes! Brilliant even! ~ty (talk) 17:06, 15 August 2012 (UTC)

• Note: Children are included in the DSM-IV criteria of DID.DSM-IV page 529 MathewTownsend (talk) 00:44, 16 August 2012 (UTC)

Reply: Great point! Could we not just add the information from the DSM IV then? Would this work? ~ty (talk) 00:49, 16 August 2012 (UTC)

• Note -moved extended personal thoughts by Tylas on Review on Boysen's Childhood DID to article talkpage. MathewTownsend (talk) 18:57, 17 August 2012 (UTC)
• Note - moved more personal thoughts by Tylas to the article talk page. Agree we shouldn't be adding more until the reviewer responds. MathewTownsend (talk) 02:20, 19 August 2012 (UTC)

Comments from Casliber

• Putting this as a placeholder really for the time being. I have been meaning to take a closer look at this article for some time but have not had much in the way of free time. Notes will follow below soon. Most suggestions and discussion above seems sound. Casliber (talk · contribs) 01:25, 15 August 2012 (UTC)

Awesome! Another professional.~ty (talk) 01:33, 15 August 2012 (UTC)

Sorry re delay - lots of juggling. A frustrating thing about Peer Review is we now have two places to discuss material (sigh) - maybe best just to coninue over at the talk page.....Casliber (talk · contribs) 02:07, 20 August 2012 (UTC)

Would be great if you'd add comments there, as currently we are polarized 2:1 with one editor insisting that International Society for the Study of Trauma and Dissociation (ISSTD) as "the experts" and their journal Journal of Trauma and Dissociation and their Guidelines as the only correct source.

WhatamIdoing has tried to reason with the editor on her talk page[1] and [2] He didn't get anywhere. MathewTownsend (talk) 14:17, 23 August 2012 (UTC)