Talk:Dissociative identity disorder/Archive 10

This is an archive of past discussions about Dissociative identity disorder. Do not edit the contents of this page. If you wish to start a new discussion or revive an old one, please do so on the current talk page.

Archive 5

←

Archive 8

The lead is bad again

The new version of the lead simply reintroduces all the old problems. Most of the current focus of the current lead is on relatively unimportant details that people can go to the body of the article to find out for specifics. Almost f the entirety of the changes were to minimize all mention of the controversy and hide it behind jargon that most people here will not understand.

While all DSM diagnoses are controversial, it is a bit disingenuous to claim that the controversy on this one doesn't need much space in the lead because of rampant controversy. The *kinds* of controversy and level of controversy between this diagnosis and others are quite a bit different. Very few people dispute schizophrenia exists at all or think that people who report symptoms are doing so because their therapist talked them into it.

From comments above I am not surprised that Mathew is whitewashing the article, but I am very disappointed in DocJames. To pretend that this isn't a more controversial diagnosis than most while at the same time provided a quot from a reliable source on the talk page to the contrary is really bizarre.

Unless these concerns are addressed I will revert back to the previous version. WP:NPOV policy is very clear on this. DreamGuy (talk) 22:24, 29 July 2012 (UTC)

I vote against reverting. The lede is the best I have seen ever on this article. In addition, we are working on it. Please work with us instead of doing what is always done here, totally reverting all work. Please help us work on a good article for WP.~ty (talk) 22:29, 29 July 2012 (UTC)

The lede is just a start. It's not meant to be a finished product. Doc James (the expert both WLC and I called in) thinks its a good start. It got rid of all the irrelevant stuff from the lede and made it easier to edit the article. The prior one didn't follow WP:LEAD, while now we can build the lede from the article. The "controversial" stuff is not in reality nearly as important as the article makes out. Yes, there is a lack of knowledge but most mental health professionals are not immersed in controversy over DID. I vote against a revert. MathewTownsend (talk) 22:40, 29 July 2012 (UTC)

It is your *opinion* that the controversy isn't important. That is not the opinion of several experts. We go by what the experts say, not by the personal beliefs of editors here. To say that the controversy is only due to lack of knowledge when people simply do not know about the topic is nonsense when much of the controversy is coming from within the field itself. And, yes, it comes from outside too, which we also ought to cover. So far your arguments have all boiled down to what you believe and not what Wikipedia policies say we should do. DreamGuy (talk)

Reply to Mathew - Exactly! I agree that it is a good start and we should keep working on it.~ty (talk) 22:46, 29 July 2012 (UTC)

First of all I never stated that this disorder is not more controversial than most. I simply stated that they are all controversial to one degree or another. The lead contains "DID is one of the most controversial psychiatric disorders with no clear consensus regarding its diagnosis or treatment." after I updated it. ADHD has also been called the most controversial pediatric diagnosis. We discussion this controversy within the forth paragraph there. And discussing the controversy in the forth paragraph here makes sense as well. That is 25% of the lead which should be sufficient weight. Doc James (talk · contribs · email) (if I write on your talk page please reply on mine) 22:53, 29 July 2012 (UTC)

If I inadvertently misrepresented your stance, I apologize. The version of the lead had one to two sentences maximum on the controversy itself and did not even include the word controversy. I personally can agree that 25% of the lead is reasonable -- provided that the rest of it does not include content that violates NPOV by presenting highly disputed information as if it were not disputed. I am trying very hard to be reasonable and in no way want to give any side undue weight, but it seems like a couple of people here don't get that at all. DreamGuy (talk) 23:19, 29 July 2012 (UTC)

With respect to Wikipedia policy DreamGuy has support to revert to the previous version. One is not to start an edit war following this but to start a WP:RfC. Doc James (talk · contribs · email) (if I write on your talk page please reply on mine) 23:20, 29 July 2012 (UTC)

Question for Doc - What do we need to work on to make the current version something that is not bait for reversion? Give me a task and I am on it!~ty (talk) 00:46, 30 July 2012 (UTC)

Consensus for the Dx and treatment of DID

Can we agree that this is a misleading statement that is currently in the lead? "Consensus is NOT lacking in the diagnosis and treatment of DID." I would think that the DSM-IV gives a consensus for a Dx of DID and the 2011 revised treatment guidelines ISSTD gives the guidelines for the treatment of DID. If this is not enough here is a [http://psycnet.apa.org/psycinfo/2011-28153-001/ current review article by some major brains in the area of trauma and DID: Brand, Bethany L.; Myrick, Amie C.; Loewenstein, Richard J.; Classen, Catherine C.; Lanius, Ruth; McNary, Scot W.; Pain, Clare; Putnam, Frank W. . This review appears to agree with the 3 phase method already widely in use and suggested by the ISSTD.~ty (talk) 21:12, 29 July 2012 (UTC)

I changed the lede - see what you think. Though ISSTD is not a reliable source, being an advocacy organization, so can't be used. MathewTownsend (talk) 21:20, 29 July 2012 (UTC)

What I think! Here is a huge cyber hug!!!! How about the Brand et al review? ~ty (talk) 21:21, 29 July 2012 (UTC)

I do not see concerns with the changes by Mathew. Some of the content however maybe should have been moved lower in the article if not already there.

With respect to consensus regarding DID we have this reference here "Dissociative identity disorder (DID) is probably the most disputed of psychiatric diagnoses and of psychological forensic evaluations in the legal arena." from a 2008 review article [1]. Maybe the wording could be improved? Many if not all of the diagnosis in the DSM are controversial, not just this one :-) Doc James (talk · contribs · email) (if I write on your talk page please reply on mine) 21:27, 29 July 2012 (UTC)

Reply to Doc - Exactly! What makes DID such a target is that child abuse (as a cause) is involved - from what I have read in many professional sources.~ty (talk) 22:10, 29 July 2012 (UTC)

Reply to Doc and Mathew - Yes - from all I have read, this is how I see what the words controversy mean. Feel free to use any of my text here: Ignorance surrounds the valid psychological diagnosis of dissociative identity disorder, a mental disorder that is included in the Diagnostic and Statistical Manual of Mental Disorders, fourth edition (DSM IV) and the proposed DSM 5 - a serious mental disorder which is at least as common as Schizophrenia.

Also from what I have read from many experts, the existing "controversy" has a lot to do with severe child abuse and the a percentage of the public's denial that such child abuse even exists even though we read about it in newspapers.~ty (talk) 21:44, 29 July 2012 (UTC)

re controversy. I agree. I think all too much emphasis is placed on the controversy in the article (when controversy is endemic in psychology/psychiatry) and not enough on our lack of knowledge and the true confusion that surrounds this diagnosis and personality functioning in general. It's a much more interesting topic when explored as knowledge seekers than in taking sides over a controversy. MathewTownsend (talk) 21:52, 29 July 2012 (UTC)

Reply to Mathew - Yes! A voice of reason!~ty (talk) 22:06, 29 July 2012 (UTC)

(edit conflict)

Please improve the wording in the lede! And I know also it's not complete. I just wanted to take the lede down a few notches in tone. MathewTownsend (talk) 21:41, 29 July 2012 (UTC)
Re Brand, Bethany L; etc. - I would say no. It's a survey of practices and recommended treatment interventions among 36 international expert therapists treating patients with dissociative identity disorder and dissociative disorder not otherwise specified. How were these "experts" selected? Seems like a small number to survey internationally, so likely not representative of therapists or "experts" treating these patients. MathewTownsend (talk) 21:41, 29 July 2012 (UTC)

Reply to Mathew - Me? I am allowed to edit the page or Doc James? I would prefer to put it here and one of you edit or it will probably just be reverted.~ty (talk) 21:51, 29 July 2012 (UTC)

Reply to Mathew - I will check the library and see what I can find to answer your questions, but this is a review. Is it less of a work than other articles used on the DID page?~ty (talk) 21:47, 29 July 2012 (UTC)

If you look at the article on ADHD another very controversial diagnosis. We give controversy a paragraph in the lead. We need to let the literature lead.Doc James (talk · contribs · email) (if I write on your talk page please reply on mine) 23:09, 29 July 2012 (UTC)

Reply concerning the Brand et al article- this work is akin to a review of studies each of which reports case study results. It's what you do when you have nothing better. It's a beginning. We'd all like something better, but if this is the best we have, we go with it and make clear that our generalizations are standing on the ground we'd prefer. To just dismiss this is not correct unless you have something better to use. In addition, one of the authors is Frank Putnam, the Frank Putnam, Chief of the Unit on Dissociative Disorders, Laboratory of Developmental Psychology, Intramural Research Program, National Institutes of Mental Health. He was a member of the DSM-IV Work Group on Dissociative Disorders. He's not ever going to put his name on any publication that isn't top notch. His was one of the first books I ever read on DID.~ty (talk) 00:51, 30 July 2012 (UTC)

Unable to find the Brand article in pubmed? Doc James (talk · contribs · email) (if I write on your talk page please reply on mine) 16:05, 30 July 2012 (UTC)

Could it be because it quite new Dec 2011? I can't get it on pubmed either or anywhere but here.

citation: A survey of practices and recommended treatment interventions among expert therapists treating patients with dissociative identity disorder and dissociative disorder not otherwise specified. Brand, Bethany L.; Myrick, Amie C.; Loewenstein, Richard J.; Classen, Catherine C.; Lanius, Ruth; McNary, Scot W.; Pain, Clare; Putnam, Frank W. Psychological Trauma: Theory, Research, Practice, and Policy, Dec 5 , 2011, No Pagination Specified. doi: 10.1037/a0026487 ~ty (talk) 16:37, 30 July 2012 (UTC)

Discussion about what goes in the Lead/Lede

Note: this used to be a direct response to something Tylas wrote above. Since I wrote it that whole section was changed by Tylas to read something else entirely. This is an ongoing problem here. The prevalence information does not belong in the lead. It is highly disputed, especially as critics either say it has been vastly overdiagnosed or may not even really exist. Putting these numbers without a very clear explanation of the controversy is a huge violation of NPOV policy. DreamGuy (talk) 22:28, 29 July 2012 (UTC)

Prevalence information does belong in the lead. And Doc James supplied the references for it and also said the ratio of male to female with the disorder should be there. MathewTownsend (talk) 22:50, 29 July 2012 (UTC)

Well then we disagree, strongly at that. If the prevalence is listed, then we explicitly need to explain that other sources dispute those numbers. To do otherwise would blatantly slant the article. I have no problems with the gender ratios being in the article itself somewhere, but in the lead it would be too specific of a detail when there is a lot more valuable information that deserves to be there. DocJames was talking about the length of the lead, and if we are imposing some length, then we need to pick the most important information, which is: 1) short summary of what it is, 2) that it's controversial and why, 3) other stuff if there's room. I also think some commentary on how experts would explain that the ratios of diagnosis are so vastly different between genders would be useful later in the article. DreamGuy (talk) 23:07, 29 July 2012 (UTC)

I reverted my own edit. I missed the new references and such. My apologies! ~ty (talk) 23:04, 29 July 2012 (UTC)

There is a lot of high quality recent literature that gives prevalence rates. They do mention that the quality of the data is poor. Thus I have added this. Still think the numbers are significant enough to deserve mentioning. Doc James (talk · contribs · email) (if I write on your talk page please reply on mine) 00:52, 30 July 2012 (UTC)

The approach of "X is the estimated prevalence/recover/incidence/temperature but this is controversial" is my preferred approach to these things - we should note what the best guess is. If that best guess is controversial - we must note that as well. Best is if we can say why it is controversial, but the lead will probably be very long anyway and that might be too much detail. WLU (t) (c) Wikipedia's rules:^simple/_complex 01:22, 30 July 2012 (UTC)

How is the lead in "There is little systematic data on the prevalence of DID"? Doc James (talk · contribs · email) (if I write on your talk page please reply on mine) 03:13, 30 July 2012 (UTC)

Cause

I am working on prognosis right now, but if anyone is doing cause, I found a good 2008 pubmed review article on DID. J Trauma Dissociation. 2008;9(2):249-67.Familial and social support as protective factors against the development of dissociative identity disorder. Korol S.~ty (talk) 03:12, 30 July 2012 (UTC)

This is another great reference that gives a good 10 page overview. Could probably be used a dozen times or more. http://books.google.ca/books?id=2RzFWRIAsPAC&pg=PA681 And bring this page a ways to GA.Doc James (talk · contribs · email) (if I write on your talk page please reply on mine) 03:32, 30 July 2012 (UTC)

Prognosis

I am working on this section here. I am reading a bunch on this, since of all the aspects of DID to study, this is the one that I have not looked into in depth, so this is interesting. Help is always greatly appreciated! ~ty (talk) 13:27, 30 July 2012 (UTC)

This is what I have. Anyone have suggestions or changes for this? First is the text for the DID page, followed by support for the last sentence.

Generally, the earlier one is diagnosed the better the prognosis and even greater if diagnosis and treatment is obtained during childhood. Prognosis becomes far less optimistic if not appropriately treated. Successful treatment (psychotherapy) for adults usually takes years depending on ones goals; to operate as a unified self and free of the effects of DID or become coconscious, still having DID. If the typical 3 phase treatment for DID is completed, dissociative boundaries are reduced resulting in a unified self and elimination of the effects and symptoms of trauma memories. Therapy is not easy and hospitalization can be required for some patients. This chronic disorder rarely resolves spontaneously if ever. [2][3] [2] Individuals with primarily dissociative symptoms and features of post traumatic stress disorder normally recover with treatment. Many patients have a history of being sexually abused as a child and often cope by abusing alcohol or other substances - a negative way of coping with their victimization. Those with co-morbid addictions, personality, mood, or eating disorders face a longer, slower, and more complicated recovery process. Individuals still attached to abusers face the poorest prognosis; treatment may be long-term - and consist solely of symptom relief rather than integration. Changes in identity, loss of memory, and awaking in unexplained locations and situations often leads to chaotic personal lives. [3] Individuals with the condition commonly have histories of failed suicide attempts and self-harm. [4][5][6] ~ty (talk) 16:22, 30 July 2012 (UTC)

Can you put references inline? Typically for a controversial topic every line should have a reference behind it. Also if you use the "quote=" you can stipulate what text from the source supports your paraphrasing. The last line also pertains to treatment not prognosis. Doc James (talk · contribs · email) (if I write on your talk page please reply on mine) 16:37, 30 July 2012 (UTC)

Thanks Doc! I can and will do so quite happily! ~ty (talk) 16:41, 30 July 2012 (UTC)

Well darn - let's move that last and all that supporting information to treatment!~ty (talk) 16:41, 30 July 2012 (UTC)

It we could be more specific when it comes to referencing by adding the exact quote from the reference in question that would make things easier. Typically our paraphrasing should not be much different than the original. Here is a an example.

Doc James (talk · contribs · email) (if I write on your talk page please reply on mine) 21:08, 30 July 2012 (UTC)

Reply to Doc James - I can do that. I felt like I was stealing when doing that. I had read in WP rules that we are suppose to write things in our own words, but I can see how it will reduce conflict with some editors. Thank you. :) ~ty (talk) 21:44, 30 July 2012 (UTC)

Question on reference - For this section that WLU deleted before I had a chance to ask you if this book was okay to use: Prognosis becomes far less optimistic if not appropriately treated. {citation needed} Successful treatment (psychotherapy) for adults usually takes years depending on ones goals; to operate as a unified self and free of the effects of DID or they might choose to become coconscious and still have DID. {citation needed}

Attachment, Trauma and Multiplicity working with DID by V. Sinason 2011

It's not a major text book, but the info above is a bit beyond a text book. It is a major work on DID however. Sinason ~ty (talk) 21:42, 30 July 2012 (UTC)

It is safest to stick with major textbooks at least initially. Doc James (talk · contribs · email) (if I write on your talk page please reply on mine) 22:45, 30 July 2012 (UTC)

I am really starting to see why! I am getting confused! Break time! Thanks Doc!~ty (talk) 22:51, 30 July 2012 (UTC)

Treatment

DID treatment is supported by a body of prospective data in a well-defined population using valid and reliable measures of psychopathology.

Support for this statement

Summary of Ross and Halpern (2009): Ideally, treatment outcome studies are "...randomized, prospective, double-blind placebo-controlled.." designs. "Prospective" means we start with a condition, apply treatment, then see what happens. Most DID studies are retrospective - we're done with treatment, and we look back. This is important because retrospective studies do not have dropouts, a significant issue in proper studies.

Where DID is concerned, there are multiple essentially insurmountable hurdles here:

Psychotherapy clients usually can figure out if they are receiving placebo (there goes half of the "blind");
Whereas a typical drug treatment study lasts 6-8 weeks, DID treatment lasts years (5 or more); it is therefore far harder to retain study subjects in DID studies than in drug studies. Most psychotherapy last far less time than does DID therapy, so the problem is not just in comparison with drug studies.)It is not feasible, nor ethical to offer someone in need of treatment a placebo for years.
For many reasons, obtaining funding for treatment outcome studies in DID is significantly more difficult than with other conditions.

What this means is that there likely will not be a really good treatment outcome study for DID any time soon, if indeed ever. The hurdles are really big. Therefore, in the meantime acceptance of other studies if the norm.

Next, we look at treatment outcome studies in mental health. Here, they look only at medication. There is no mention of psychotherapy models other than theirs. This is a major flaw of their analysis, for a reason that may not be obvious. Basically, psychotherapy typically gets better results than do drugs. For many technical reasons Ross and Halpern (2009) summarize psychotropic medication, in general, as not especially effective. Reported successes are almost surely inflated due to inherent research design errors.

Moving to DID, Ross and Halpern (2009) comment that these "patients" are so complicated that they would simply be excluded from normal treatment studies, because: most have been psychiatric inpatients or have been suicidal, and most have other Axis I disorders including addictions. Such subjects just are not used in treatment studies - too many factors are in play to do a good study.

They then present treatment outcome data for participants in their treatment program in Texas.

Ross and Halpern's (2009) data is prospective, but not randomized, double-blind, or placebo controlled.
All subjects were given formal assessments (involving objective tests) at admission, at discharge (an average of 18 days later), and at 3-month followups.
All 46 participants had a dissociative disorder (DID or DDNOS - no one gets hospitalized for the others), and major depression, at admission; 85% had borderline personality disorder; 59% had somatization disorder; 48% had a substance abuse disorder. Remember, these are inpatients - the most serious subgroup of the DID diagnostic group. Non-inpatients will not look so complicated, and will respond to treatment better.
As a group, objective assessments of symptoms showed significant improvement at discharge, with continuation of improvement seen at 3-month followup.
A separate, more detailed, two-year follow-up study of 54 graduates of their treatment program revealed that 12 (22%) had achieved stable integration at that point. Why not more? Because at admission they were at all stages of recovery, with some having been diagnosed only a few months earlier, and full treatment usually requires at least 5 years, they say. They estimate that at 5 years, 50% will have achieved integration. This recovery rate is as good as that for recovery from depression using medication, and with simple subjects who don't have all sorts of complicating, interfering factors.
None of those achieving integration in their 2-year study had any kind of substance-abuse problem.

My conclusion from the Ross and Halpern (2009) book: "The treatment techniques described in this manual are supported by a body of prospective data in a well-defined population using valid and reliable measures of psychopathology."

Do you have a PMID for reference in question or an ISBN and page number / google book url? Doc James (talk · contribs · email) (if I write on your talk page please reply on mine) 16:51, 30 July 2012 (UTC)

You don't have this wonderful book on your bookshelf? ;) of course. Here you go: Ross book and here is more: {{cite book|last=Ross|first=C.|title=Trauma Model Therapy: A Treatment Approach for Trauma Dissociation and Complex Comorbidity|year=2009|publisher=Manitou Communication|location=TX|isbn=098218512X}

Hum prefer that we use major textbooks... This may be okay for some stuff but the book I gave above would be less questioned.Doc James (talk · contribs · email) (if I write on your talk page please reply on mine) 18:38, 30 July 2012 (UTC)

Repy to Doc - Worry not! :) I am, as we type, adding references from both Merk Manual and the book you gave on the prognosis section - since much of the original text that was there was from the Merk Manual online. It is an awesome book ref by the way and as you said - it can be used for many things in this article! I was just working on that other project before you posted it since the entire book is on treatment. It's a good one! ~ty (talk) 18:44, 30 July 2012 (UTC)

Brand et al. 2011 is an interesting read, which emphasizes the lack of clear evidence for DID treatment, having instead to rely on the impressions of clinicians. Oddly it doesn't appear to be pubmed indexed. It's also a bizarre primary-looking document (but used three times in the article already). WLU (t) (c) Wikipedia's rules:^simple/_complex 20:13, 30 July 2012 (UTC)

Taken out of context

Never mind~ty (talk) 22:42, 30 July 2012 (UTC)

I'm not sure what the problem is with this.

Traditionally dissociative disorders such as DID were attributed to trauma and other forms of stress that caused memory to separate or dissociate, among other symptoms, but research on this hypothesis has been characterized by poor methodology. So far, experimental studies, usually focusing on memory, have been few and the research has been inconclusive.^[1] It became a popular diagnosis in the 1970s but it is unclear if the actual incidence of the disorder increased or only its popularity. An alternative hypotheses for its etiology is that DID is a product of techniques employed by some therapists.

^ Howell, E (2010). "Dissociation and dissociative disorders: commentary and context". Knowing, not-knowing and sort-of-knowing: psychoanalysis and the experience of uncertainty. Karnac Books. pp. 83–98. ISBN 1-85575-657-9. {{cite book}}: Unknown parameter |editors= ignored (|editor= suggested) (help)

It's meant to give a brief summary of the history in the lead. In the lead, citations are discouraged in general, because everything in the lead with be explained in the article with citations (though controversial material should be cited there. I meant it to summarize the "controversy" without becoming bogged down in it, so we could get on with the article. Once we write the article, we'll know what to put in the lead. Currently the lead is just a "stand-in" as it will have to contain a concise summary of the major points in the article, and there are many, many points that are going to end up in the lede (lead). MathewTownsend (talk) 22:28, 30 July 2012 (UTC)

Never mind! Now it makes sense. I thought WLU did it, which was so totally confusing to see what he was getting at. Ignore this section!~ty (talk) 22:41, 30 July 2012 (UTC)

I understand now. It was just so unlike WLU and I became confused. Really paranoia is not a sign of DID. ~laughing Should I just delete this whole section. It might be very confusing to others who read it.~ty (talk) 23:13, 30 July 2012 (UTC)

Best to work on the body of the text first and the lead last

The section on epidemiology is full of primary research papers. Are there not secondary sources that give ranges for different populations? Once this section and the controversy surround prevalence has been improved here than a smaller summary can be added to the lead. ~~My comments above on gender ratios belong here not in the lead.~~ Belong in both spots maybe... Doc James (talk · contribs · email) (if I write on your talk page please reply on mine) 23:29, 29 July 2012 (UTC)

Reinders, A. A. T. S. (2008). "Cross-examining dissociative identity disorder: Neuroimaging and etiology on trial". Neurocase 14 (1): 44–53. DOI:10.1080/13554790801992768. PMID 18569730 is a primary article, not a review, and is cited 8 times in the article. MathewTownsend (talk) 00:31, 30 July 2012 (UTC)

Pubmed does list this as a review article and that is typically what I go by.Doc James (talk · contribs · email) (if I write on your talk page please reply on mine) 01:28, 30 July 2012 (UTC)

Farrell, H. M. (2011). "Dissociative identity disorder: Medicolegal challenges". The journal of the American Academy of Psychiatry and the Law 39 (3): 402–406. PMID 21908758 is cited 5 times in the article and is a primary source and not a review article. MathewTownsend (talk) 00:37, 30 July 2012 (UTC)

Yes, agree with both points. Casliber (talk · contribs) 00:39, 30 July 2012 (UTC)

I don't understand why this is being described as primary and not a review article. Please explain your reasoning instead of just assertnig it. DreamGuy (talk) 02:41, 31 July 2012 (UTC)

Putnam, Frank W. (1989). Diagnosis and Treatment of Multiple Personality Disorder. New York: The Guilford Press. pp. 351. ISBN 0-89862-177-1. RW (2002). "The duality of the brain and the multiplicity of minds: can you have it both ways?". History of Psychiatry 13 (49 Pt 1): 3–17. DOI:10.1177/0957154X0201304901. PMID 12094818. This is a primary and not a review article, yet is cited 4 times in this article. MathewTownsend (talk) 00:42, 30 July 2012 (UTC)
van der Kolk BA, van der Hart O (December 1989). "Pierre Janet and the breakdown of adaptation in psychological trauma". Am J Psychiatry 146 (12): 1530–40. PMID 2686473. Primary source cited 2 times. MathewTownsend (talk) 00:58, 30 July 2012 (UTC)

I would support the retention of the primary sources DocJames removed from the epidemiology section (here). Again pointing to MEDRS, WP:MEDREV seems to use this sort of situation as an example of when a primary source would be appropriate (they use average age of onset for autism, estimated percentages in specific countries seems similar to me). This is mostly because I don't think there are review articles going into the numbers the way these primary sources do, particularly in these countries. Natch, if someone can find one then that's better, but until this point I think they're a reasonable inclusion.

I'm really not sure how these articles are considered primary. In my experience, primary means a study performed on a group of subjects while secondary synthesizes multiple primary articles. Per Wikipedia:MEDRS#Definitions, these would seem to fit the examples given ("Examples include literature reviews or systematic reviews found in medical journals, specialist academic or professional books, and medical guidelines or position statements published by major health organizations."). They may not be meta-analyses or systematic reviews, but they do seem to be literature reviews that verify relatively uncontroversial points for the most part. In the case of Reinders and Rieber, they're secondary sources (as I understand them, again I'm surprised to see these considered primary) discussing areas the authors have specific expertise in, neuroimaging and the history of psychiatry. Farrell doesn't seem to be a lawyer, but has published two articles (though very similar ones!) on DID and the law. The Putnam books should be replaced if possible, and I'm not upset by removing them outright.

I would be very surprised to have been so wrong for so long. Doc and Casliber, you think that the Reinders, Rieber and (both, there are two) Farrell articles should be removed as primary sources? WLU (t) (c) Wikipedia's rules:^simple/_complex 01:15, 30 July 2012 (UTC)

Mathew, while I agree that medical literature changes pretty quickly, making information obsolete within five years or so, I wouldn't argue the same for historical information. Putnam, 1989 for instance, is cited solely in the history section, which is one place where I think older sources (if not contradicted by newer sources) are acceptable. I think the same goes for Rieber as well, since legal doesn't change the same way medical does. I would be more concerned if these were 20-year-old sources used in the diagnosis, treatment, etiology or other specifically "medical" sections. WLU (t) (c) Wikipedia's rules:^simple/_complex 01:19, 30 July 2012 (UTC)

This very large textbook of psychiatry gives numbers and is better than the primary sources that where there before IMO. It also discusses how rates have changed with time. Schatzberg, edited by Robert E. Hales, Stuart C. Yudofsky, Glen O. Gabbard ; with foreword by Alan F. (2008). The American Psychiatric Publishing textbook of psychiatry (5th ed. ed.). Washington, DC: American Psychiatric Pub. pp. 681–682. ISBN 9781585622573. {{cite book}}: |edition= has extra text (help); |first= has generic name (help)CS1 maint: multiple names: authors list (link)

ADHD is a similar condition which went from being very rare to being exceedingly common with similar associated controversy. Doc James (talk · contribs · email) (if I write on your talk page please reply on mine) 01:21, 30 July 2012 (UTC)

I agree that for the sections on history as well as "society and culture" which includes legal we need not be as stringent on referencing. Yes these are sort of literature reviews but not marked as such by pubmed (except for the first one which is listed as a review article). I have had this question myself and will touch base with pubmed. Doc James (talk · contribs · email) (if I write on your talk page please reply on mine) 01:24, 30 July 2012 (UTC)

Doc, I agree that we need to do the body first and the lead should be based upon the body. Unfortunately that's not what recent edits were doing. The gender disparity, for example, is interesting and definitely deserves a place in the body, but it got added the the lead right away and then tacked on to the body as an afterthought. Out of all the wide things that can be in the lead, something that was just tossed together and up to this point anyway showed no overall notability seems like an odd choice. And I say that as someone who put that back into the lead when reverting to the old consensus version because nobody objected to it. (As mentioned above, I think experts talking about why they think the gender disparity is there -- or if there are any studies on that specific topic somehow -- would be very valuable to the article, as compared to tossing it out there as a factoid.)

Recent discussions on the controversy suggested it shouldn't be there because there was no controversy section, which is missing the point entirely. The things mentioned in the lead that some people tried to remove (or reword so that it was incomprehensible to an average reader) are fully detailed in the body of the article in various places. They were being removed despite the fact that they accurately summarized the article. And we have discussion on this very talk page that explained all of that already, multiple times. It is incomprehensible how someone who was advocating editing the lead last was busy chopping it to pieces and adding wholly new material never before present in the article. DreamGuy (talk) 02:34, 31 July 2012 (UTC)

Good Article status first step to a stable version

I recommend working this up to GA status as this is then a consensus version that folks can refer back to when problems arise in the future. FA would be better but probably a tad ambitious.....Casliber (talk · contribs) 00:51, 30 July 2012 (UTC)

Another helper! Yay! Thank you Sir for being here!~ty (talk) 01:00, 30 July 2012 (UTC)

I agree, Casliber, and so thankful that you turned up. I know how busy you are and so I'm all the more thanful. MathewTownsend (talk) 01:42, 30 July 2012 (UTC)

There's no hope for GA status while edit warring is going on and brand new changes that violate policy are being added daily. We already do have a working consensus version that folks can refer back to when problems arise, however. Nobody is happy with it, but nobody can agree on specifically what should be changed. DreamGuy (talk) 02:26, 31 July 2012 (UTC)

Controversy

While we do not typically have sections on controversy. Maybe in this article like for ADHD we should? We could put this text there?

DID is a controversial diagnosis. Supporters attribute the symptoms to the experience of pathological levels of stress, which they say disrupt normal functioning and force some memories, thoughts and aspects of personality from consciousness (dissociation);^[1]^[2] an alternative explanation is that belief in these dissociated identities is artificially caused by certain [[psychotherapy|psychotherapeutic]] practices and increased focus from the [[mass media|mass media]], leading the patients to imagine symptoms that did not exist prior to therapy.^[3]^[4]^[5]^[6]^[7]^[8] The debate between the two positions is characterized by intense disagreement.^[3]^[5]^[6]^[8]^[9]^[10]

Doc James (talk · contribs · email) (if I write on your talk page please reply on mine) 01:36, 30 July 2012 (UTC)

I agree that a controversy section is needed somewhere, and the above catches the gist of it well. Casliber (talk · contribs) 02:05, 30 July 2012 (UTC)

Actually I disagree, and think WP:STRUCTURE would apply. The thing is, the controversy over DID, from what I've read, exists in nearly every section. You can find criticisms of the epidemiology, the etiology (particularly the etiology actually), the diagnosis, the history, the diagnosis, pretty much everywhere has someone venturing a criticism of the traumagenic position, with a comment, rebuttal or counter-criticism from someone from the traumagenic camp. This is part of why the article is hard to write, there's at least two positions for every section. Having a single controversy section either reduces the controversy by making it appear like it's a fringe position, or does exactly what STRUCTURE says the page shouldn't - forces you to read the whole page twice because once you reach that section you realize there's a whole other view that's not expressed.

That being said, sometimes it is hard to tease out the controversies as many of them to span multiple sections. WLU (t) (c) Wikipedia's rules:^simple/_complex 11:05, 30 July 2012 (UTC)

Agree with Casliber, James and Santos - WLU, with all due respect Sir you have stated before that you have no interest in reading about the trauma etiology of DID - perhaps if you did, the controversy you feel is present would ease. There is an accepted view of DID etiology and there is a very select minority that has a different view. I agree with Casliber and Doc James on their proposed setup on this issue - which is also what Daniel Santos proposed up at the top of the talk page a couple of weeks ago.~ty (talk) 14:07, 30 July 2012 (UTC)

The etiology is accepted only by a portion of the mental health community. Traumagenesis is not considered the universal and uncontroversial cause of DID the way bacterial infection is the cause of a urinary tract infection. Per WP:NPOV, both need to be represented and neither should be portrayed as the "right" one. It's controversial and contested. WLU (t) (c) Wikipedia's rules:^simple/_complex 15:19, 30 July 2012 (UTC)

Those are good point WLU. Agree most of the discussion of different aspects of each section as long as well referenced (controversial or not) should take place in that section. I guess a specific section on controversy would be only if one position was not main stream or coming from a social or political group rather than a scientific one. Doc James (talk · contribs · email) (if I write on your talk page please reply on mine) 16:03, 30 July 2012 (UTC)

Moving all controversial content to the bottom

This is not what I meant. Thus I have moved the content that was moved in these edits [2] and [3]. Doc James (talk · contribs · email) (if I write on your talk page please reply on mine) 20:47, 30 July 2012 (UTC)

Doc, there are already parts of the article talking about the controversy (at least there was last time I checked, but with the edit warring it may have all disappeared again). The lead is supposed to summarize the article, which is why the part you suggested moving was in the lead in the first place.

Also, generally speaking it's not a good idea to create a specific controversy section and move all criticism to that area. This essentially creates a ghetto area where those with a POV can try to minimize a viewpoint, and that's one step away from moving. Controversies should be explained organically as the various topics arise. Controversies about causes should be covered in the causes section. Controversial aspects in the history are covered in the history section. Avoiding controversy sections is a principle explained in one of the NPOV policy pages (or, again, it used to be, sometimes things get deleted). DreamGuy (talk) 01:46, 31 July 2012 (UTC)

As you will have noted I have replaced some of the content surrounding controversy back in the lead. And tried to keep aspects that some view as controversial within the usual section. Have moved the section on controversy to diagnosis as that is what the controversy deals with.Doc James (talk · contribs · email) (if I write on your talk page please reply on mine) 01:49, 31 July 2012 (UTC)

Please see Wikipedia:Criticism#Avoid_sections_and_articles_focusing_on_.22criticisms.22_or_.22controversies.22. DreamGuy (talk) 01:51, 31 July 2012 (UTC)

Yes you are right. Will need to look at thinks further. Doc James (talk · contribs · email) (if I write on your talk page please reply on mine) 01:53, 31 July 2012 (UTC)

That's an essay, but it's elaborating on a policy, WP:STRUCTURE. WLU (t) (c) Wikipedia's rules:^simple/_complex 03:37, 31 July 2012 (UTC)

The lead must discuss the controversy

Tylas reverted my edit with the summary "because we are working on it. Please be patient rather than reverting. Work with us - not against us please!" Tylas, I am part of that "we". The controversy is a very notable part of DID, probably far better known to most clinicians than the specifics of treatment. The body still contains considerable discussion of the controversy, and the lead should summarize the body. The version before my edits contained only two sentences on the controversy, with no indication of why DID is controversial, only that it is. The reasons can be summarized briefly, and in my opinion should be included. I'm not sure why you think my opinion should be casually discarded when it is quite in keeping with WP:LEAD. WLU (t) (c) Wikipedia's rules:^simple/_complex 20:02, 30 July 2012 (UTC)

Reply to WLU - Yes, of course you are Sir, but you can see from the talk page that we are working in one direction, to come in and revert the work is not nice. I would very much love you to work with us and create an A WP article. ~ty (talk) 20:05, 30 July 2012 (UTC)

"Working in one direction" is not appropriate per WP:NPOV. I did not revert any work, I replaced a block of text that was inappropriately removed. An "A" or featured article will require a discussion of the controversy, including in the lead. If you can not come up with an appropriate policy or guideline-based reason for the lead to not reflect the body, then please replace it. "It's not nice" is not such a reason, particularly when I am asking civilly, and with good reason. The body and the lead should not be one-sided and should not exclude a key position and major side of the controversy. WLU (t) (c) Wikipedia's rules:^simple/_complex 20:11, 30 July 2012 (UTC)

Reply to WLU - Perhaps I misunderstand, but I thought those that are here to peer review decided the controversy will go into once paragraph and one of them placed it. I would that that is the direction. I do however disagree strongly with your reasons. I offer my apology if I am wrong and wait to see what those who are reviewing the article report.~ty (talk) 20:17, 30 July 2012 (UTC)

Has anyone put in a request for a peer review? Doc James and Mathew Townsend are here as editors, not as peer reviewers. Why do you disagree with my reasons? WLU (t) (c) Wikipedia's rules:^simple/_complex 20:26, 30 July 2012 (UTC)

The top of the article says the article IS currently being peer reviewed. ~ty (talk) 20:31, 30 July 2012 (UTC)

I submitted it for peer review a few days ago. But I'm not sure how peer review works. The directions said it might take a while. MathewTownsend (talk) 20:38, 30 July 2012 (UTC)

The top of the talk page says to start a peer review, click on one of the hyperlinks. But primarily, the fact that a page may be peer reviewed isn't a justification for removing an edit which I can only see as appropriate per WP:LEAD. I am aware of no policy or guideline that says a page should omit a significant controversy from the lead while under peer review, and you still haven't answered my question - why do you disagree with my reasoning about leaving the controversy text in the lead? I am asking civily and politely, please do me the courtesy of responding, or admit you don't have such a reason (and in that case - please replace the text). WLU (t) (c) Wikipedia's rules:^simple/_complex 20:55, 30 July 2012 (UTC)

Reply to WLU: The group here agreed to work on the body for now, then work on the lead. If we are going to work on the lead, then I too will start debating what should and should not go there. Is this where we want to go group, or should we stick to working on the body for now?~ty (talk) 21:02, 30 July 2012 (UTC)

(edit conflict)

sorry, WLU, not sure what you are saying. There is a misunderstanding. Nothing in the article has been removed/added/changed because of the peer review. I started it to seek feedback from the people who do peer reviews. As you can see from the peer review page Wikipedia:Peer review/Dissociative identity disorder/archive1, there's been no responses. And I really don't expect any, given the topic. MathewTownsend (talk) 21:12, 30 July 2012 (UTC)

ps I think the peer reviewers won't edit the article. They'll leave suggestions/criticisms etc. on the peer review page linked above. MathewTownsend (talk) 23:03, 30 July 2012 (UTC)

Tylas, that is not a valid objection, the material I am putting in the lead is already in the body.

Mathew, my comment was directed at Tylas. I don't know how peer review works, but throwing it directly into an archive seem standard - probably need to wait a bit before someone looks over it. WLU (t) (c) Wikipedia's rules:^simple/_complex 23:15, 30 July 2012 (UTC)

Probably be a good idea to hold off on peer review for a bite until the article has advanced some. Doc James (talk · contribs · email) (if I write on your talk page please reply on mine) 23:55, 30 July 2012 (UTC)

Yes, strongly agree. At the rate things are going, the version they start reading will be different from the version that exists by the time they finish :( WLU (t) (c) Wikipedia's rules:^simple/_complex 03:35, 31 July 2012 (UTC)

Removing well supported content

I am unsure why this well supported content was removed? [4] and [5] One set of text was supported by major textbooks and the other by a 2011 review article (PMID:2182904) Doc James (talk · contribs · email) (if I write on your talk page please reply on mine) 20:51, 30 July 2012 (UTC)

Reply to Doc James - Did I do it? I moved a small amount of text from under Controversy because it seemed that WLU was complaining that there was still controversy in the article as a reason to put it back in the lead. Did I mess up? If so, I am sorry. I did not mean to do anything wrong! It was suppose to go to the bottom of the page with other text moved for the same reason, but with all the editing one part did not make it there.~ty (talk) 20:56, 30 July 2012 (UTC)

Per WP:STRUCTURE we should be locating it in the appropriate section of the page, not moving it to the bottom. At some point everyone will have to discuss the whether it is appropriate to have a controversy section at all, or whether to interstitch it throughout the article. WLU (t) (c) Wikipedia's rules:^simple/_complex 21:01, 30 July 2012 (UTC)

If we where to move everything that was controversial to the bottom the whole article would be there by the looks of it :-) If it is well supported by the evidence it should be in the body of the text. If the controversy is legal in nature or involves social groups than it should occur at the bottom. My position anyway. Doc James (talk · contribs · email) (if I write on your talk page please reply on mine) 21:14, 30 July 2012 (UTC)

Still a bit confusing, but I think see what you are getting at. Then the only controversy that should be in the body is therapist induced and that is not controversy. It is accepted. Is there anything else that is not social or legal that is controversial other than if someone watched a TV show or not?~ty (talk) 21:29, 30 July 2012 (UTC)

The division between "controversial" and "not" is arbitrary and somewhat false; editors consider points controversial, pages should include the full debate. Any place a recent reliable source indicates debate or controversy should note it as appropriate, that includes treatment, etiology, diagnosis, etc. One of the problems with going to the J Trauma Dissociation is that it's specifically from a traumatology perspective; note that most of the articles in that journal ignore the controversy, while sources found elsewhere discuss it with varying degrees of detail. WLU (t) (c) Wikipedia's rules:^simple/_complex 22:44, 30 July 2012 (UTC)

Cherry picking references: When writing about a subject one wants the work of experts. The majority of experts work on trauma research because that is where mainstream science believes we should be working and those researchers publish in a variety of journals including the one that you want ousted. To remove one journal, is like saying we need to reject all the article written with the point of view of iatrogenisis because that's all they study or they don't believe that child abuse has anything to do with having a dissociative disorder. You can't just cut out progress like that.~ty (talk) 23:25, 30 July 2012 (UTC)

So all the people who write and publish about the iatrogenic/sociocognitive position in well-respected peer reviewed journals are not experts?

I've never asked for J Trauma Dissociation to be excluded. WLU (t) (c) Wikipedia's rules:^simple/_complex 23:34, 30 July 2012 (UTC)

Yes, you have asked for that journal to be excluded before. It was just not today.~ty (talk) 23:45, 30 July 2012 (UTC)

I never said they were not expert. I am sure they are on what they do study, but the paper by Kluft (or was it Ross) pointing out problems with the research does stick in my mind, but it's not up to me. I am not an expert and I don't pick and choose. In the academic world there are certain names that come up as being considered experts, but they are not my list - they are a list by others that are qualified to say who is an expert and who is not. ~ty (talk) 23:45, 30 July 2012 (UTC)

If we simple use recent secondary sources and give similar weight that they give we should be good. Doc James (talk · contribs · email) (if I write on your talk page please reply on mine) 23:53, 30 July 2012 (UTC)

Please do not put words into my mouth. I may have urged caution in the past, I very much doubt that I ever said it could not be cited. In particular, I am not saying it now. While J Trauma Dissociation is definitely a source for the traumagenic position, for much of the rest of the article, particularly the controversies, I think we'll need to look into other journals as well.

The threshold for citation is publication venue. That means university or scholarly press books, and peer-reviewed secondary sources. There's no magic list we can draw upon for who is correct to cite and who is not. WLU (t) (c) Wikipedia's rules:^simple/_complex 02:08, 31 July 2012 (UTC)

Long and Boorish

What somehow appeared in the lede today: It became a popular diagnosis in the 1970s but it is unclear if the actual incidence of the disorder increased or only its popularity. An alternative hypotheses for its etiology is that DID is a product of techniques employed by some therapists and disagreements between the two positions is characterized by bitter debate.[11][12][13][14][3][15] Critics of the diagnosis point to characteristics such as the rareness of the diagnosis before 1980, the lack of children with DID, vagueness of the diagnostic criteria and terminology, changes in the number and forms of patient alters and the clustering of the diagnosis around certain clinical groups as evidence that the condition is due to social role-play rather than a true mental illness.[15][16]

This is a mess, a long paragraph with [11][12][13][14][3][15] all this to try and give credit to one sentence. The problem is that probably most of this stuff was taken out of context. If you are going to say there is "bitter debate" then you need to say about what exactly, not just give a long list of papers that might have similar words, that actually mean totally different than what you are implying. The Text book Doc James posted answers all these claims (I think all quite actually), but to go back and forth on all this would make the article long and boorish and still never tell people what DID is. This is just old boring stuff. What is interesting is what is real and now understood.

Critics of the diagnosis point to characteristics such as the rareness of the diagnosis before 1980, the lack of children with DID, vagueness of the diagnostic criteria and terminology, changes in the number and forms of patient alters and the clustering of the diagnosis around certain clinical groups as evidence that the condition is due to social role-play rather than a true mental illness.[15][16] This is just more of the same~ty (talk) 23:41, 30 July 2012 (UTC)

See Citation overkill and other related articles.

While adding footnotes is helpful, adding too many can cause citation clutter, which can make articles look untidy in read mode, and unreadable in edit mode. If a page has extra citations that are either mirror pages or just parrot the other sources, they contribute nothing to its reliability while acting as a detriment to its readability. One cause of "citation overkill" is edit warring, which can lead to examples such as "Garphism is the study[1][2][3][4][5] of ...". Extreme cases have seen fifteen or more footnotes after a single word, as an editor desperately tries to shore up his point and/or overall notability of the subject with extra citations, in the hope that his opponents will accept that there are reliable sources for his edit.

One cause of "citation overkill" is edit warring, which can lead to examples such as "Garphism is the study[1][2][3][4][5] of ...".

Ironically, excessive use of citations has the effect of decreasing credibility rather than increasing it! I advise we use a few, well chosen, reliable sources to support our statements. MathewTownsend (talk) 23:58, 30 July 2012 (UTC)
Agree one or at most two good citations is all you need to support something.Doc James (talk · contribs · email) (if I write on your talk page please reply on mine) 00:08, 31 July 2012 (UTC)

Reduced to two citations is fine, I've also tried to shorten the explanation and added Cardena's alternative explanation (lack of training of clinicians to recognize the diagnosis. WLU (t) (c) Wikipedia's rules:^simple/_complex 00:45, 31 July 2012 (UTC)

Great Doc James (talk · contribs · email) (if I write on your talk page please reply on mine) 00:48, 31 July 2012 (UTC)

I agree there were more citations than necessary. Ideally we don't need any, because the lead summarizes the article, and the article has them, but historically a number of people tried to argue that there were no reliable sources for those statements and insisted on citations on the lead, and it all exploded from there. It looks like this change has broad consensus, so that one should be done. DreamGuy (talk) 02:20, 31 July 2012 (UTC)

I have tried at one point in time to follow the rule of "lead does not need referencing" in some of the good articles I was writing. Readers just continually come along and add ^{[CS Ch.{{{ch}}}]} template. Thus I have given up. Are readers expect citations and do not want to have to read the body of the text to find them. This is one of the rules that deserves ignoring. Doc James (talk · contribs · email) (if I write on your talk page please reply on mine) 03:23, 31 July 2012 (UTC)

Someone has updated the recommendations on citations in the lead to mach with reality :-) [6] Doc James (talk · contribs · email) (if I write on your talk page please reply on mine) 03:27, 31 July 2012 (UTC)

I managed it once, and once only, on Bioidentical hormone replacement therapy. And still some filthy mucker slipped one in, where it stands out like a severed thumb in a pasta salad :) WLU (t) (c) Wikipedia's rules:^simple/_complex 03:34, 31 July 2012 (UTC)

Signs and Symptoms

I noticed in the signs and symptoms section this was written: "Despite research on DID including structural and functional magnetic resonance imaging, positron emission tomography, single-photon emission computed tomography, event-related potential and electroencephalography, no convergent neuroimaging findings have been identified regarding DID..."

But then the last sentence of the same paragraph states, "DID patients may also demonstrate altered neuroanatomy."

This seems confusing and contradictory to me.

(Sorry if I'm just misunderstanding or going about things the wrong way; I'm new here.) Dirajero (talk) 00:24, 31 July 2012 (UTC)

Good catch and welcome to the DID article. :) ~ty (talk) 00:41, 31 July 2012 (UTC)

And these are not really signs or symptoms so moved to a section on "pathophysiology" Doc James (talk · contribs · email) (if I write on your talk page please reply on mine) 00:50, 31 July 2012 (UTC)

Lots of good work on the page today Doc and Mathew!~ty (talk) 01:26, 31 July 2012 (UTC)

Stop making controversial changes without consensus

Everyone is talking every which way and making large numbers of edits to the article, and very few of these changes are being discussed. Even fewer are receiving anything like a wide agreement.

On controversial topics, the goal of NPOV policy is not that everyone is happy, but that everyone (or as many people as possible) agree that the wording that exists is fair and accurate. Many of the recent edits have been in areas that anyone looking at this topic page would know were already discussed as unfairly slanted and inaccurate. We all know this is a very controversial article. Nobody can in good conscience ignore that. To ignore that and rush ahead suggests you are not interested in working with others. It shows bad faith in your edits here. I know people are emotional, but everyone needs to follow our policies. I can understand why newbies might make this mistake, but for editors who have been around a long time it's incomprehensible.

Per WP:BRD, I have reverted to the last stable version. DocJames above said I had every right to do so in this situation, so I did. This version is the version closest to the one that had consensus for many months here, other than a few changes made to fit what everyone I've seen so far agreed on (removing mention of Sybil, though I did so reluctantly until we have better wording we can agree upon) DreamGuy (talk) 02:17, 31 July 2012 (UTC)

Tylas reverted, and this is one case where I agree. Many of the improvements your revert over-wrote were in my opinion (and in the opinions of Tylas, Doc James and Mathew since none reverted them) good ones. The version that was stable for so long is obviously not acceptable to many people, and while I do think there was obvious consensus that Tylas' hundreds of edits resulted in a poorer page, I don't think that means we should preserve the old version indefinitely. Many of the changes were citation improvements, removal of older or primary articles, and the use of respected textbooks. These are changes I think worth keeping. I don't think a neutral page means portraying the traumagenic position as wrong, any more than portraying the iatrogenic position as wrong. As much as Tylas' edits go too far towards the traumagenic position, I think your edits go too far in the opposite direction. WLU (t) (c) Wikipedia's rules:^simple/_complex 03:01, 31 July 2012 (UTC)

It doesn't have to be indefinitely, but we don't need a massive change immediately either. Every policy that mentions these situations say consensus first, and we don't have that, not by a long shot. If you think there are changes we can agree on, like the paring down of citatons in the lead, then we can discuss those individually and make just those changes. But completely changing the wording of the lead, deleting stuff and so forth is completely unacceptable without prior discussion and consensus. Period. And it's a shame I'm the only one who gets that. If you think my edits go too far, please explain why, because I do not see you commenting on any of that on this talk page. DreamGuy (talk) 03:11, 31 July 2012 (UTC)

Well, that didn't last long. At this point there are three or four completely different versions people are reverting to. Nobody can agree which of these directions to go, so why do people think they are justified in moving forward? This unfortunately means we have to move onto something a little stronger...DreamGuy (talk) 03:05, 31 July 2012 (UTC)

One does not typically need consensus to replace primary sources with secondary ones. As consensus is that this is what we should be doing. If you see content that was removed and supported by secondary sources which you feel should not have been removed. You may return it. But removing all the new secondary sourcing is not the best form. Doc James (talk · contribs · email) (if I write on your talk page please reply on mine) 03:19, 31 July 2012 (UTC)

I think this page in general needs a solid updating. The top section of the page is a sorted-by-year list of sources on DID, many of which are less than 5 years old (though I believe I put that list together looking for sources specifically on the iatrogenesis model, to illustrate that it was indeed still a large concern in DID research). My e-mail inbox has eight articles from 2012, and another eight from 2011 that could be integrated. The last time this page got a good top-to-bottom reworking was, I believe, when ResearchEditor was around in 2007(!) and a lot has happened since then. I plan on adding as many of the new sources I can over the next couple days, and I don't think this is an approach that can be argued with. From there, it would probably be a good idea to scrub out many of the older ones. Can we agree, in principle, on such an approach? Focus on finding and integrating sources between 2008 and 2012 and bringing the page up to date?

My greater concern with the page is that it's quite long, and the sections are splintering, overlapping and generally needs what I would characterizes as a good combing. So many editors working simultaneously is contributing to this, but frankly I don't have a solution. WLU (t) (c) Wikipedia's rules:^simple/_complex 03:31, 31 July 2012 (UTC)

Useful to add an exact quote to the citation template to support your paraphrasing. Makes thing easier to verify.Doc James (talk · contribs · email) (if I write on your talk page please reply on mine) 03:33, 31 July 2012 (UTC)

Notice here where Doc James suggests using a quote in citations.~ty (talk) 00:14, 1 August 2012 (UTC)

to WLU - interesting addition!

Your latest addition ("Disturbed and altered sleep has also been suggested as having a role in dissociative disorders in general and DID in specific.^[11]" is very interesting. Now that I've been looking at the recent literature, I see that the research has turned toward examining the memory functioning from a neurological view, examining avenues like altered sleep etc. Since psychiatry in general is leaning more toward genetic and neurobiological influences, it makes sense that if the field would drop this dichotomy of real versus play acting and start actually examining what is going on, it could get really interesting! Thanks! MathewTownsend (talk) 02:36, 31 July 2012 (UTC)

I got that paper from one of the authors, if you e-mail them, you can probably get a free copy. Disappointingly (for this page), it focuses on dissociation in general rather than DID in particular and that's about all the milking I can get from it for this page. You might be interested in Lynn, 2012 (DOI 10.1177/0963721411429457) which has more on experimental tests of memory, the iatrogenic/sociocognitive position, and experimental stuff (again, requested from the author). Very recent, but also pretty one-sided... WLU (t) (c) Wikipedia's rules:^simple/_complex 02:52, 31 July 2012 (UTC)

Here's a previewable google book that that goes into some of these features as well [7]. It's weird how there really do seem to be two camps and ne'er the 'twain shall meet. WLU (t) (c) Wikipedia's rules:^simple/_complex 03:03, 31 July 2012 (UTC)

(edit conflict)

Plus it makes sense since suggestibility is so prominent in DID that there are several reveiw articles on the effectiveness of using these methods and others. e.g. Cognitive behavioral hypnotherapy for dissociative disorders., Memory in dreams, Memory in dreams., Integrative psychotherapy: combining ego-state therapy, clinical hypnosis, and eye movement desensitization and reprocessing (EMDR) in a psychosocial developmental context (a little old - 2001), Cognitive behavioral hypnotherapy for dissociative disorders. 2012, Dissociation and memory fragmentation in post-traumatic stress disorder: an evaluation of the dissociative encoding hypothesis. 2012. etc. (I just grabbed a few, but these seems to be increasing evidence linking (or relating) PTSD with dissociative disorder. (Don't want you to think I'm flaky - I'm just staying up very late to watch the Olympics!) MathewTownsend (talk) 03:14, 31 July 2012 (UTC)

Ugh, am I the only one who hates EMDR and thinks it's pretty rank quackery?

You should read Lynn 2012, you'll find it very interesting I think. It's also a great updating of the iatrogenic/SC position, suggesting lines of evidence I hadn't seen before (including the sleep one). WLU (t) (c) Wikipedia's rules:^simple/_complex 03:20, 31 July 2012 (UTC)

Oh, I agree about EMDR. But I had a neurophysiology prof in graduate school who said that if acupuncture had any effectiveness then he would have to throw out everything he knew about neurophysiology. Well ... MathewTownsend (talk) 03:32, 31 July 2012 (UTC)

Acupuncture works, it's pretty good at reducing pain and nausea. Whether that is due to specific effects, or merely because it is an unusually potent placebo is still being debated. Amusingly, when a study finds acupuncture and placebo acupuncture are both equally better at relieving pain and nausea than no treatment, proponents proclaim that means acupuncture works. I wonder how the FDA would respond if Pfizer said "our drug is as effective as placebo, compared to waiting list controls" during a drug application. WLU (t) (c) Wikipedia's rules:^simple/_complex 22:57, 31 July 2012 (UTC)

Pathophysiology

This is a great new section. I am going to do some more reading on this. Thanks to whoever added it!~ty (talk) 00:22, 1 August 2012 (UTC)

To Tylas - there's no hurry!

Wikipedia has no deadline per WP:NODEADLINE. No one person should write this article and no one should be making big changes in one day. This article is a collaboration. Many of your problems come from doing too much too fast. Slow down! This article is about a diagnosis, not about anyone's personal experience. MathewTownsend (talk) 01:11, 1 August 2012 (UTC)

But all I did was the prognosis section that Doc James asked me to do. It was a short little thing. I have not been working on anything else. I don't understand?~ty (talk) 01:29, 1 August 2012 (UTC)

I can slow down. I did not want to disappoint anyone here who is working hard and not do my part. I felt really bad I did not get more of that section done last night, so I hit it hard all day today. I will keep working on prognosis. okay? It still needs a lot of work. :) ~ty (talk) 07:56, 1 August 2012 (UTC)

re "shame"

Under "Signs and symptoms" where it says: "The majority of patients with DID report a history of abuse, both sexual and physical during their childhood." I edited out the phrase "resulting in feelings of shame and fear that might inhibit reporting symptoms." This is no different from any individuals who have a "history of abuse, both sexual and physical during their childhood", so this is not characteristic of those diagnosed with DID. I hesitated about the inclusion of "Individuals with DID may experience distress from the consequences of DID rather than from the symptoms themselves." It is cited to an article recommending future directions for DSM-V - but since I don't have access to the whole article, I don't know what empirical evidence Spiegel is basing this on. MathewTownsend (talk) 23:43, 1 August 2012 (UTC)

This is from the book that Doc suggested we use I believe. Guilt and shame. Quite a topic in itself! I will see if I can find the exact location for you. Just a thought - keep in mind that those who have DID were usually severely abused. They have parts of the self that exist that are saturated with those feeling - not to discount the abuse of ANY child!~ty (talk) 23:50, 1 August 2012 (UTC)

Hales-prognosis - quote=Furthermore, because most patients with DID report histories of sexual and physical abuse, the shame associated with that experience, as well as fear of retribution, may inhibit reporting of symptoms.

See page 683 - under the title "Course" on the right side of the page - it is a little less than halfway down that column. Also I have no idea why it has a citation of Spiegel. I did not do that. ~ty (talk) 00:09, 2 August 2012 (UTC)

You have to use judgment. Just because it comes out of a book, does it make sense that the "shame" etc. is characteristic of those diagnosed with DID, more so than others with similar histories? Or is the book writer suggesting that it is diagnostic of DID that they experience so much more "shame" etc. than the others with similar histories? Or what? What is the point of adding a well known fact characteristic of persons who were abused as children to the "Signs and symptoms" of DID? MathewTownsend (talk) 00:23, 2 August 2012 (UTC)

I do not argue deleting it. I do however believe it does make sense. Other victims of child sexual abuse will feel shame of course! - but they do not have dissociated parts, that can totally take over and refuse to be subjected to shame -keeping in mind the ANP does not even know of the abuse normally. I know it does not make sense unless you have lived it or worked with those that have it, but these parts come out and take over stopping many such actions as going to therapy. For many with DID, finally asking for help is one of the hardest things they will ever do in their life. Either way you choose is fine with me. It is not something that needs to be in the article at all.~ty (talk) 00:29, 2 August 2012 (UTC)

Also, I don't think it was me that put it there. I had some of that text under prognosis, but did not add anything to the signs and symptoms that I remember or can find. It might have been me, but I don't think so. I never say never though!~ty (talk) 00:32, 2 August 2012 (UTC)

(edit conflict)

But Hale says that most are amnesiac for the physical/sexual abuse. So if they don't remember it then of course they're not going to report it. Also, he is speaking about data from specific samples.

Yes, the host at the time in life will not remember the event, most of the time, but other parts of the self do. It depends on who is out and doing the talking.~ty (talk) 00:46, 2 August 2012 (UTC)

What about my comment above: "Individuals with DID may experience distress from the consequences of DID rather than from the symptoms themselves." It is cited to an article recommending future directions for DSM-V - but since I don't have access to the whole article, I don't know what empirical evidence Spiegel is basing this on." Are you saying it's true but not from Speigel? From some other source? (I don't see it on the page - half way down on page 683 as you reference). Can you clarify? MathewTownsend (talk) 00:39, 2 August 2012 (UTC)

Please stop adding quotes

If you don't know how to add a quote to a citation template, ask. I don't see the need for a large number of quotes anyway, the points that are having quotes added to them are not being challenged that I can see, nor are they so fine or nuanced that they need a direct quotation to avoid misrepresentation. Quotes add to the length of the page (and the page is already quite long), and for the most part do not add to the interpretation. If the text says "DID rarely if ever goes away without treatment", I do not see a need for a quote saying "but dissociative identity disorder does not resolve spontaneously". WLU (t) (c) Wikipedia's rules:^simple/_complex 21:54, 31 July 2012 (UTC)

I did ask Mathew. He is easy to work with. Also easy to work with is Doc James, who contrary to you, would like the quotes added. I never know which points will be challenged Sir. I have found this to be a wonderful process and I quite like it. It does bring credibility to each statement. Oh sorry, that I put in the credits you respect Doc James. I don't mean to put words in your mouth! Forgive me! I was not thinking and can't remove it. ~ty (talk) 22:02, 31 July 2012 (UTC)

Notice how I don't talk about whether I think you are hard to work with? Please do me the same courtesy.

You asked why I did not ask. I did, I just did not ask you. It was a simple statement Sir.~ty (talk) 00:08, 1 August 2012 (UTC)

Basic information, like that found in the Merck manual, is not likely to be challenged and does not need a quote. I can't think of an instance where a quote would resolve an issue, they are generally about weight and rarely specific sources. I see quotes only useful when one editor challenges the summary of another, on a source both agree to use. I can't remember an instance of that happening on this page. WLU (t) (c) Wikipedia's rules:^simple/_complex 22:29, 31 July 2012 (UTC)

Some of the quote didn't actually match the text. For instance, the text said

Patients are often hesitant to complete psychotherapy due to fear and shame from the abuse suffered in their childhood

but the book quote was:

Furthermore, because most patients with DID report histories of sexual and physical abuse, the shame associated with that experience, as well as fear of retribution, may inhibit reporting of symptoms

I will make it closer to the original quote and add more original quote so the meaning is more clear. I debated, but did not want to make the quotes too long Sir.~ty (talk) 00:10, 1 August 2012 (UTC)

Reporting symptoms isn't the same thing as completing therapy. Also consider from the text:

Resolution of symptoms of DID is important to more than just the DID patient but to the well-being of off-spring as well. Parenting is quite difficult for the person with DID, even though it might not be obvious to them, severe dissociation and other actions affects their children

Yeah, that can be taken out. I debated, but many with DID do finally give in and get help just for their kids when they will not for themselves.~ty (talk) 00:12, 1 August 2012 (UTC)

Compared to the actual citation:

One last consequence of DID is the subject's inability to be adequate parents, at least while symptomatic

If quotes are being used, even if they aren't, it is important to stick close to what the source actually says, not extrapolations. WLU (t) (c) Wikipedia's rules:^simple/_complex 23:22, 31 July 2012 (UTC)

I will go back through these and see one by one and copy the text even closer, but I will use common terminology used when talking about DID.00:08, 1 August 2012 (UTC)

I agree with WLU. Quotes are not needed, indeed they clutter the text, unless it is an unusual or unlikely statement. Also, it's not good to cite the same source over and over per WP:UNDUE. No one authority needs to be used as a source more than a few times. MathewTownsend (talk) 00:18, 1 August 2012 (UTC)

ps A quote means using the exact wording of the source. That's what a quote is. If you rephrase it, it's not a quote. MathewTownsend (talk) 00:20, 1 August 2012 (UTC)

Reply to Mathew - I am trying to do as Doc James suggested, but Mathew I also respect you and would like to do what is WP correct and respect the opinions of both of you on this. Doc said to stick to grad school level texts for now and sources like the merk manual. I would love to use the multitude of books and journal articles that I have, but for now he said to start with this. I can certainly add the others to this! Can we have him explain why? I assume this is to stop much of the controversy. This is a time consuming process, but if it is what is needed, I can do it.

Question for WLU and DG - without the quotes there would you 2 delete anything from the prognosis section that is there? Understanding that I will make those things WLU addressed above closer to the actual quote? ~ty (talk) 00:30, 1 August 2012 (UTC)

Question for All - I fixed what WLU suggested. I see WLU fixed some citation errors with spelling of merkdoc - I was about to do that, but thank you. Is there anything else in the prognosis section any of you would like me to look at? I am not done with it by the way. I just had to go for a while.~ty (talk) 00:58, 1 August 2012 (UTC)

There's nothing wrong with noting that parenting is difficult for DID patients if the source actually says this.

The prognosis section is long, and mostly sourced to Merck - which if you look at the bottom of that page, was last updated in 2008. And further, comparing the prognosis section to the Merck page used to verify, there is a large section of text that doesn't seem to match what is said on the Merck page.

Overall, I simply think the prognosis section needs better sources. Merck is OK, but now old. I'm sure there's other, more recent sources that could be tapped. WLU (t) (c) Wikipedia's rules:^simple/_complex 01:11, 1 August 2012 (UTC)

Okay, please don't delete what is there however. Let me know on this talk page and I will work on it. I keep getting different opinions from you, Mathew and Doc. I am going to wait and see what Doc and Mathew say about this if you don't mind. It is a group effort. I do have so many sources, but am doing what Doc James suggested.~ty (talk) 01:32, 1 August 2012 (UTC)

Also if something belongs in therapy, please let me know so I can weigh in on it as well, and if it goes there then it can be moved - not deleted please.~ty (talk) 01:33, 1 August 2012 (UTC)

Nothing is ever lost, anything removed is in the page history. However, you should not be replacing something in the prognosis section because it was once on the page. You should only add things to the prognosis section if they can be verified by reliable sources. Sources are not an excuse or hurdle you need to put in something you think should be there - sources are the threshold that must be passed for any material to be included. Pages are based on sources, not on editor opinion. Hales has a section on prognosis (though they call it "Course"), that is another source besides Merck to draw upon. Your time might be better spent looking for multiple sources that discuss prognosis, reading them all carefully and then trying to draw out the common themes. It looks like there's not much on prognosis out there, and this is backed up by other sources that discuss the lack of controlled clinical trials for patients. WLU (t) (c) Wikipedia's rules:^simple/_complex 12:15, 1 August 2012 (UTC)

Please Tylas, the prognosis section is not solely your responsibility. Best to add a little now and then per day, while keeping the balance of the entire article in mind. Then reflect on the whole and read more sources. IMO, there isn't a whole lot to say about prognosis as there are few reliable secondary sources that address the subject, especially review articles. For example, the statement: "Prognosis can be excellent; case studies report that most cases of DID resolve with proper therapy, but there are no controlled trials." This sentence gives us little useful information as case studies by their nature are not valid for outcome statements. And they are usually written by proponents of the therapy who are going to report favorable outcomes and therefore are not NPOV. No controlled trials means we have no information on prognosis. MathewTownsend (talk) 13:25, 1 August 2012 (UTC)

Reply to Mathew - Good morning Sir and I am sorry this is so long, but there is a lot to say! First I applaud all your work on the DID page, as well as Doc James. I know it's not an easy page to work on! Second, I have no problem with the actual facts about iatrogenesis and agree with those actual facts, but I want to reflect current research and knowledge on the entire page, not a biased POV - what that balance is appears to be a problem on WP, but it is not in the mainstream academic and research world as is clearly shown in the grad level text book - Hales. I would happily work on the iatrogenic section and you would see that I am not biased, but that is a controversial section so I stay clear of it as much as possible. I do "feel" (which is a bad word to use, but appropriate here) that I need to defend my actions, taking into account that I am so far from perfect it's silly, but I am trying my best! Of course the few lines on the prognosis section that were there when I was given the task to work on by editor Doc James (more lines now than a few days ago) are not my entire responsibility and I don't want them to be, but at the same time WLU should not come in and simply delete that work either that I spent the entire day yesterday working on, following methods I was directed to use. If parts of the text belong under therapy, then they should be moved there, not deleted. Each line was carefully paraphrased from direct quotes that were given in the citations. WLU had some complaints, so I tried my best to fix what he saw as problems. We should discuss such things here on the page. right? It gets confusing to newer editors, like me, when things just disappear almost as soon as they are posted. I want help, and am trying my best to address all the problems brought up. I see changes in the prognosis section and that's great - really awesome even, but just reverting or deleting as WLU often tends (no offense Sir, just stating things I have understood them to be and I could be wrong. I am not trying to attack you, but to understand this process) is a problem - at least how I interpret it. Then I learn this method by watching him and am jumped on by him if I delete something of his. It gets confusing to say the least! As for reading more sources, I think I have read all the sources on the page (although I see a new section that I have never looked into, but I am afraid to spend time there since I think WLU wants that section removed. I have not paid a lot of attention to that, so don't quote me on this.) Other than finding some text books when I get to a town, there is not a bunch more out. I do have many, very current books that go beyond grad level texts, however that I would love to use but I am trying to do as Doc directed me to as in which references to use first - then I was planning to add others since I think this was his meaning (but I could be wrong). I have had trouble finding much about prognosis too. Most of what is in that paragraph on prognosis was already there and probably written by WLU, and I started to work with that text. Most of the section was already paraphrased from Merck before I started - if I remember right, but it's hard to know for certain with all the total page versions and reverts. I was asked by Doc James to focus on the prognosis section, so I did. I feel like a puppet being pulled in all directions. I want to do the right thing, but it seems on WP there is no such thing, since each editor has different views of the rules and guidelines, but, I can roll with the punches. I do try and do as both you, Mathew and Doc James direct me to because, so far from what I have seen, you and Doc are both unbiased and totally respectable editors, who have advanced knowledge of WP. You seem to know your psychology and Doc knows medicine. I think it's a great balance. As far as the prognosis section, I did do all the work in my sandbox and then asked everyone here to please look at it there and give suggestions (I even posted it on the talk page) - none were given other than Doc James, who asked me to add direct quotes to each statement, so I did - that was new to me, so I added a little at a time to the DID page in my best attempt to not mess things up as far as WP formatting, citations, etc. I am not an expert WP person, and I humbly bow to that and LOVE direction by kind, knowledgeable editors such as yourself and Doc. I have read a great (not the pop culture - I avoid that as much as possible) deal about DID and should be allowed to work here, no matter what the edits show, I actually have few on the page compared to WLU. We have to keep in mind that the "whole" of the page was a personal copy written and edited almost solely by WLU and kept in his own sandbox then put here all at once. This is the version we began with a few days ago. Which means that WLU has written almost the entire DID page himself. It's confusing that I cannot work on a small section, with that in mind. AS for clinical studies, I can post here the reasons why there are not clinical studies (but I am sure you know) and I have no disagreement to that sentence of the paragraph being deleted? I would have exaggerated on why there is a lack of clinical DID studies in that line, but I was trying to keep it brief. One last note or question - it is is better that I read through the entire article and make small changes here and there - that is the sort of thing I LOVE to do!!!!! I would be so happy to do that instead of be limited to a small section. Let me know. Until then, my plan for the day is to work on references and clean up the prognosis section and address any concerns others have about it. I enjoy teamwork and don't want to be out here working on the article alone! In fact, I would dread that! :) ~ty (talk) 15:21, 1 August 2012 (UTC)
reply to Tylas

A good way to start is to read the article and make little copy editing changes, like spelling etc. Then, since this is a controversial article, why don't you discuss any proposed changes on the talk page first. Then, make a few small changes and see how they are received by other editors. No one should be putting such a large amount of text that if it's deleted they can't handle it. (And remember, anything you write is still in the article history and can be retrieved.) If someone makes a deletion you disagree with, take it to the talk page and discuss it. Remember, other editors, like WLU, have worked long and hard on this page over a period of years so think how they are going to react when you make many major changes to the article without consulting others in a few days. MathewTownsend (talk) 16:13, 1 August 2012 (UTC)

Reply to Mathew - Of course I can do that, but have tried this before and even my smallest edits were reverted and never agreed to. But now there are some new editors here, that just might work! Good suggestion! You are very helpful Sir! Thank you! I so want the group to be able to make progress on the DID article and I want to be a helper, not a problem! Keep setting me straight. I appreciate it!~ty (talk) 16:49, 1 August 2012 (UTC)

If your edits insert text that is not verified by sources, in particular if it is not verified by the source attached to it, I very much should remove it, not move it to a different section. WP:V is a core content policy, and should not be ignored.

Hales is not the only source, and many other sources newer than 2008 indicate DID is still controversial.

It may be harsh, but competence is required; you would almost certainly do better on this page if you spent more time working on other pages, then returned with a better understanding of wikipedia based on topics you are not so personally invested in. Edits are problematic depending on whether they comply with policies and guidelines, and whether they misrepresent sources. Based on my reading of the quote given and the text attached, the sources were being misrepresented. The best of intentions doesn't change the fact that the sources were made to say something other than what they actually said.

"Unbiased" doesn't mean "someone who agrees with me". Bias always refers to our policy on reliable sources and neutrality, and neutrality is determined by weight and volume of sources.

Your summary of the version stored in my sandbox is incorrect. WLU (t) (c) Wikipedia's rules:^simple/_complex 01:24, 2 August 2012 (UTC)

Here is an example of something I consider problematic. In this edit Tylas changed the text from "DID may be the result of role-playing rather than separate personalities, though others disagree, pointing to a lack of incentive to manufacture or maintain separate personalities" to "DID may be the result of role-playing rather than separate parts of a personality, though others disagree, pointing to a lack of incentive to manufacture or maintain separate personality states" with an edit summary "parts of the personality - there is no such thing as multiple personalities". The actual source does not say "parts" or "personality states", it specifies separate personalities. This is an edit that is problematic because the editor in question has an opinion about the subject matter, and alters the wikipedia page to conform to their personal opinion rather than what the source actually verifies. This is a case where a direct quote might be helpful, but not near so helpful as Tylas abandoning the practice of editing the page to conform to their idea of what is "real" DID and instead editing according to the actual sources. WLU (t) (c) Wikipedia's rules:^simple/_complex 01:45, 2 August 2012 (UTC)

Reply - I agree with Mathew and think that using "personality states" solves all problems. Knowing what a personality is from a personality state is not an opinion.~ty (talk) 21:46, 2 August 2012 (UTC)

Using the word "personality" simply continues to confuse people about not only DID, but basic psychology. I refer you back to my section titled Psychology 101 which explains this. I will look for it on the talk page. It might have been archived. 21:42, 2 August 2012 (UTC)~ty (talk) 21:46, 2 August 2012 (UTC)

I can't find it even in the archives so I added a new section to explain why I think this is very important. It's under "personality confusion."~ty (talk) 22:11, 2 August 2012 (UTC)

Proposed changes for the DSM-V

"Despite the lengthy history of the psychopathology of dissociative disorders, and the intense study by Pierre Janet in the first part of the last century and by Jean-Martin Charcot before him, dissociative disorders have been largely disregarded since Freud and have not received serious attention again until recently.[45] Prior versions of DSM have avoided consideration of etiology in an effort to distance itself from Freudian psychology. DSM-V is attempting to reintroduce etiology; and the "development of a pathophysiologically based classification system" has been advocated such as investigation of the neuroevolution of "stress-induced and fear circuitry disorders and related amygdala-driven, species-atypical fear behaviors of clinical severity in adult humans."[46]"

I just read this. Wow! Now that is someone that understands what is going on both with history and the DSM. Thank you to whoever did this. It's a breath of fresh air! I think advocated is spelled wrong. Will fix for you. :) ~ty (talk) 01:08, 1 August 2012 (UTC)

Ever so Bold Mathew - How about we put that section under the category of DSM history and make is DSM history and current events or something like that? :) ~ty (talk) 21:05, 2 August 2012 (UTC)

reply to Tylas

Because it hasn't happened yet and when it is published it may not reflect the published proposals. It is not part of the diagnosis now, which is what this article is about. And Casliber is a psychiatrist, and he thinks its inappropriate to include it. (And I agree with him.) He wrote Major depressive disorder which you might take a look at as a model for how an article on a psychiatric diagnosis should be formatted. MathewTownsend (talk) 21:33, 2 August 2012 (UTC)

:Reply to Mathew - I can understand that and thought it would be the cause, but thought I should ask so the question did not sit in my head. Thanks. :) ~ty (talk) 21:43, 2 August 2012 (UTC)

Signs and Symptoms

Sorry, missed that! Thanks for pointing me to it! :) I read those words in the WP article and did not know what that was suppose to mean? What is "consequences of DID?" vs "symptoms themselves?" - again I don't think I was the one that wrote this. This must have showed up yesterday in all that moving commotion going on. I only wrote in the prognosis section yesterday - I believe. I will look at the reference. I might have that book or article. The words themselves are not familiar at all to me - I don't remember reading them, but will look and see what I come up with. ~ty (talk) 00:46, 2 August 2012 (UTC)

It seems like it means that the DID person would be perfectly happy being DID, except the real world trips them up e.g. people in general become exhausted dealing with all the symptoms and don't want to deal with the person any more. They lose jobs because dysfunctional "alters" don't want to work, etc. MathewTownsend (talk) 00:59, 2 August 2012 (UTC)

I found the sentence in question. No that is not something I did.

On WP page: "Individuals with DID may experience distress from the consequences of DID rather than from the symptoms themselves.[15]"

Reference [15] is about DD in general and rec for the DSM 5.

What (Spiegel D, Loewenstein RJ, Lewis-Fernández R, Sar V, Simeon D, Vermetten E, Cardeña E, Dell PF.) say about DID in this review article is that:

RESULTS:

3. The diagnostic criteria for DID should be changed to emphasize the disruptive nature of the dissociation and amnesia for everyday as well as traumatic events. The experience of possession should be included in the definition of identity disruption.

CONCLUSIONS:

There is a growing body of evidence linking the dissociative disorders to a trauma history, and to specific neural mechanisms. ~ty (talk) 01:04, 2 August 2012 (UTC)

OK, that means it should not be in "Signs and symptoms" but in some section that discusses recent evidence and suggestions for changes in DSM-V! MathewTownsend (talk) 01:16, 2 August 2012 (UTC)

Agreed.~ty (talk) 01:17, 2 August 2012 (UTC)

Agreed also. Casliber (talk · contribs) 13:09, 2 August 2012 (UTC)

Dissociation

Here is a great review article on dissociation by David Spiegel MD. In the article it says there is controversy about what dissociation is. This article should help with that. ~ty (talk) 18:15, 2 August 2012 (UTC)

If it's about dissociation in general, then we would have to be very cautious about using it here on DID. WLU (t) (c) Wikipedia's rules:^simple/_complex 01:59, 2 August 2012 (UTC)

also, it's an editorial regarding the broad concept of "dissociation" and its the future in DSM-V. Kind of off topic here. MathewTownsend (talk) 12:05, 2 August 2012 (UTC)

Final sobering point is that DSM V is by no means clear-cut as alot of psychiatrists are very unhappy about it, so I really think we need to keep away from it until it becomes official....I will try to take a look at the paper though. Casliber (talk · contribs) 12:33, 2 August 2012 (UTC)

Spiegel also says in the same source: "We are considering proposing that there be a stress and trauma spectrum section of the DSM5 that would include the adjustment disorders, acute stress disorder, posttraumatic stress disorder, and the dissociative disorders." MathewTownsend (talk) 13:06, 2 August 2012 (UTC)

I was bold and removed the DSM-V section per Casliber above. I believe there are compelling reasons not to include it, aside from the fact that it is not a final version. It only adds more complex terminology to the article without clarifying anything. MathewTownsend (talk) 19:47, 2 August 2012 (UTC)

When talking about dissociation, it is not what it is that is "not agreed upon", it's when the label is used to mean so many different things in psychology. See page 474 for a nice explanation of this. The type of dissociation that occurs in dissociative disorders is usually referred to as pathological dissociation. Perhaps using that label throughout our article would remove confusion as to what type of dissociation it is that we are talking about - every day normal dissociation or pathological dissociation. Dell explains more about dissociation here including "Even the DSM provides a descriptive account of dissocation at the psychological level." The psychological explanation of dissociation he gives is: "Chronic dissociative symptoms are manifestations of posttraumatic self states or alter personalities. (which we are using the label of "personality states." - they are all the same thing: dissociated personality states, alter, alter personalities, posttraumatic self states.)~ty (talk) 23:55, 2 August 2012 (UTC)

Archiving

Can those who have been editing please archive threads which are resolved or repeated elsewhere. Also, if good sources have been found, can someone note that they've been added. I've just started to read this talk page and am trying to figure out where to start.....Casliber (talk · contribs) 12:44, 2 August 2012 (UTC)

The next step is to look at Medical article guidelines and Good Article guidelines and see how the article squares up. I agree that Peer Review is generally a good idea, though I worry that it will fork discussion into two places.....Casliber (talk · contribs) 12:44, 2 August 2012 (UTC)

I've manually archived a bunch of stuff. Don't think I took out anything still ongoing. Also changed archive date from 30 days to 7. WLU (t) (c) Wikipedia's rules:^simple/_complex 19:23, 2 August 2012 (UTC)

Children

There is "considerable delay between initial symptoms" and the time DID "emerges." Usually DID does not "emerge" before adolescence. name=Hales-prognosis>"Course". p. 283. {{cite book}}: Missing or empty |title= (help) See the first sentence under course on page 283. Does anyone argue this change? ~ty (talk) 00:24, 2 August 2012 (UTC)

I am confused. The WP article says "To date approximately 250 cases of DID in children have been identified, though the data does not offer unequivocal support for either theory.", but the reference I look at (and I want to read the entire article, but there is only an abstract there says: "The review produced a total of 255 cases of childhood DID reported as individual case studies" The WP statement makes it sound like there have only been about 250 cases ever of diagnosed DID. Is this right? I must admit, I have not dug much into childhood DID.~ty (talk) 00:39, 2 August 2012 (UTC)

well, my opinion is that's another statement from Hale that doesn't make sense. Who knows when it "emerges" (if that is any kind of word to use!) since it isn't diagnosed until the individual has been in "treatment" for 6+ years. As far as the number of children, do you have a citation stating otherwise? Many have stated that it is quite rare in children, but I don't know what they're basing that on. I confess I've never heard of a case in children. MathewTownsend (talk) 00:45, 2 August 2012 (UTC)

I am confused again. Where does anything say that a Dx is not made until someone has been in treatment for 6+ years? It depends on if one is lucky enough to get a good therapist or not. For me the Dx was by 3 different professionals and in an extreme short period of time. Many therapists do not under DD though, and then a person with DID gets lost in the system. It's not the person with DID's fault they are misdiagnosed.~ty (talk) 00:53, 2 August 2012 (UTC)

No, my point is the study that says 255 is not saying that this is all the children that have ever been Dx'd they are saying that is the number of children in the study. right?~ty (talk) 00:53, 2 August 2012 (UTC)

Children are in the home with their abusers. Many of their dissociated parts will go to all lengths to disguise their DID from everyone. You know.. all that introject, protector DID stuff. It's so long to go into.~ty (talk) 00:53, 2 August 2012 (UTC)

If I am allowed, I can look into very recent books by Howell, Dell, etc.. and see what they say about this. I read all that Hale wrote in that book and it agrees with everything else I have read from those who are considered to be the leaders in the field of DID, but if you have not really looked into this stuff it is easy to misinterpret. For me I don't understand the normal brain. It's hard to understand why others do not understand the DID brain. Trying to imagine it only gets one so far.~ty (talk) 01:16, 2 August 2012 (UTC)

Please consider that this source your are using is relying on studies that are from the 1980s! That's not recent reliable information suitable for this article. It is out of date. MathewTownsend (talk) 01:25, 2 August 2012 (UTC)

I am not disagreeing with the 2011 review by Boysen! I am saying that what is on the WP DID page does not say what the 2011 article say, nor does it say what the text book says. Sorry I did not make that clear. I don't know how many abused children, as I stated above could get away with telling. They would probably be punished I would not expect there to be much data on children. :)

Here is the article: RESULTS:

The review produced a total of 255 cases of childhood DID reported as individual case studies (44) or aggregated into empirical studies (211). Nearly all cases (93%) emerged from samples of children in treatment, and multiple personalities was the presenting problem in 23% of the case studies. Four US research groups accounted for 65% of all 255 cases. Diagnostic methods typically included clinical evaluation based on Diagnostic and Statistical Manual of Mental Disorder criteria, but hypnosis, structured interviews, and multiple raters were rarely used in diagnoses.

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. 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. ~ty (talk) 01:32, 2 August 2012 (UTC)

Case histories are the easiest to report, so the fact that only 255 case histories of childhood DID have been reported is significant, as it would be an easy publication to write up a case history of a childhood DID. MathewTownsend (talk) 01:53, 2 August 2012 (UTC)

The section on children came from Boysen, 2011, and I really don't think putting Hale in that section is appropriate - particularly since the entire section is about the emergence of DID in children and Hale isn't speaking at length, or specifically, about children and doesn't specify an age range. Boysen is saying that only about 250 cases of DID in children have been reported in the scientific literature. I believe my summary of the paper is accurate, but feel free to check it and we can discuss specific wording.

I got the article from Boysen himself, he would probably be happy to supply a reprint if either of you asked for it. I think his e-mail is reported in the abstract. It's a very interesting article. WLU (t) (c) Wikipedia's rules:^simple/_complex 01:57, 2 August 2012 (UTC)

I just emailed him for a copy. (not completely sure if the email went through ok.) We'll see. MathewTownsend (talk) 02:07, 2 August 2012 (UTC)

O-kay - I can't see the google book pages but have a word of caution to add. One interpretation is that identities are an extreme expression of a normal human phenomenon. Children from the age of two might pretend to be a dog or a cat and get really overinvolved. Young children have quite different reality-testing to adults. Adults don't adopt personas per se but do act differently and pervasively depending on the role they are in, hence a doctor, lawyer, rock musician will have a different selection of behaviours if they are in their job role, with friends, or family etc. Anyway this is getting off topic but I'll try and take a look at the research. Casliber (talk · contribs) 13:07, 2 August 2012 (UTC)

2 Reverts by WLU last night

PROVEIT - 1. The point here is that what WLU has on the DID page, using the Boysen reference is not what Boysen said. WLU at this point would say PROVEIT. I think he needs to type the section of the article here that says what he claims or the section be deleted.~ty (talk) 16:48, 2 August 2012 (UTC)

Personality - 2. We have agreed on this talk page that using the term personality is confusing to those who are not well versed in psychology. I do agree that "personality" is the original term used here and thus it should stay, however at the same time in writing we normally put in something like (personality states) to make it clear when the original term could be confused. Can we do this here?~ty (talk) 16:52, 2 August 2012 (UTC)

WP:PROVEIT applies to the removal of unsourced information. Feel free to request the article for the author or WP:LIB but if you haven't read it beyond the abstract, you shouldn't assume your interpretation is correct. Where did we agree that the term "personality" is confusing? I don't recall agreeing to that, and I just disagreed below. I think this is an inappropriate application of original research that is unsupported by the body of literature. If specific sources use personality states, in particular if they discuss why they use these terms, great - make that portion of the text reflect this. But if a source feels the need to defend the use of a specific term - that suggests the term is idiosyncratic rather than universal and thus should not be used in general. WLU (t) (c) Wikipedia's rules:^simple/_complex 02:18, 3 August 2012 (UTC)

Well referenced text continues to be removed

In this edit the key point that "Prognosis when untreated, is poorly understood" was removed with the inaccurate summary of "add back another part" [8]. This has now occurred a number of times and I have replaced it again. Doc James (talk · contribs · email) (if I write on your talk page please reply on mine) 17:38, 2 August 2012 (UTC)

My error. I offer apologies!!!~ty (talk) 17:46, 2 August 2012 (UTC)

Okay no worries. Doc James (talk · contribs · email) (if I write on your page reply on mine) 17:20, 3 August 2012 (UTC)

:) ~ty (talk) 17:26, 3 August 2012 (UTC)

Question about references

If a reference mentions a certain point, but the point of the reference is to disagree with what that point, should it be used as a reference to support the subject it is arguing against? One example below?

Therapist induced - header

It has been suggested that symptoms of DID may be created by therapists using techniques to "recover" memories with people who are suggestible (such as the use of hypnosis to "access" alters, facilitate age regression or retrieve memories).
[34][11][13][12][23]

[34] - Piper and Merskey are good here. That is what they argue is the iatrogenic position.
[11] - Blackwell - Can WLU show the text that says this. This book is referenced a lot in this article. Is there a link in google books or something? If not can WLU please supply the text where it says this.
[13] - Book - Cardena and Gleaves - these 2 support traumalology. pages 473 to 503. Can that be narrowed down the page that actually says this please. Page 473 says "Detractors find some of them (being DD in general) particularity DID, suspect, if not outright iatrogenic; ... then they go on to explain why the POV of the detractors is incorrect. This is not a quote supporting the theory of iatrogensis at all.
[12] - This is the same Piper and Mersky article as [34]
[23] - This one is the Boysen review that we were looking at pertaining to children. I have no idea why this reference would be here in support of this statement. ~ty (talk) 02:26, 3 August 2012 (UTC)

Cardena et al. are saying why they disagree with a position, why they think it is incorrect. It is not settled yet whether they are right in their beliefs (either side).

Sources can be used to verify positions they disagree with, an appropriate use of a source also indicates this disagreement and discusses why.

Piper & Merskey wrote two articles, part I and part II, 12 and 34 are not the same. WLU (t) (c) Wikipedia's rules:^simple/_complex 02:08, 3 August 2012 (UTC)

Question for Mathew, Doc and Casliber - Since I have learned on WP that few editors agree on fine points like this, can I also hear from Mathew, Doc and Casliber? I would think that if this is allowed it would cause confusion in any articles. If I look at a citation I want to see support for the position that it is cited for. Piper and Mersky are wonderful for this section and should be included here.~ty (talk) 02:26, 3 August 2012 (UTC)

to Tylas

Please don't cut and paste citations as you did above. Put clickable sources in your statement. The cut-and-paste numbers will change if someone adds another citation. And it makes it hard to figure out what you're saying since I have to go back and forth from your cut-and-paste to the article. MathewTownsend (talk) 15:38, 4 August 2012 (UTC)

Okey dokey - you were suppose to look that day, not wait until now. ;) Just kidding. I am happy to do so and it makes total sense! :) ~ty (talk) 15:40, 4 August 2012 (UTC)

Sources to replace or support information in the article

Interesting points Mathew. WLU, I was not looking to replace the iatrogenic stuff, I was just wondering if that was a good source to use, but since you bring it up, there are lots of references out there that could be used to show that iatrogenic and trauma/DA are not equal. Doing a quick search of reviews, here is the first one I found:

*Abstract "The incidence of dissociative identity disorder (DID) is strongly correlated with exposure to serious physical and sexual abuse. Although studies of more than 1,000 DID sufferers indicate that severe child abuse is a predisposing factor in 95% to 98% of cases (B. Braun, 1988), abuse alone is not, in fact, predictive of DID (B. Rind & P. Tromovitch, 1997). Disorganized/disoriented attachment style and the absence of social and familial support, in combination with abuse history, best predict DID (D. Howe, 2006; R. Kluft, 1984; K. Lyons-Ruth, L. Dutra, M. Schuder, & I. Bianchi, 2006)."

I am going to add this information to the trauma section, when I have a moment. Any objections before I do? It is a review article and it is newer.~ty (talk) 04:58, 5 August 2012 (UTC)

Consolidated references

As far as I can tell I've consolidated all the references so there is no more duplication of sources. WLU (t) (c) Wikipedia's rules:^simple/_complex 02:40, 5 August 2012 (UTC)

Is Medscape - (updated May 2012) a good ref?

If it is, it counters some of the claims in the WP article. Here are a couple of examples:

the most common cause of the disorder is agreed to be early, ongoing, extreme physical and/or sexual abuse
Dissociation is the disruption of the normal integrative processes of consciousness, perception, memory, and identity
is increasingly understood as a complex and chronic posttraumatic psychopathology closely related to severe, particularly early, child abuse (ref used for this: Shipman K, Taussig H. Mental health treatment of child abuse and neglect: the promise of evidence-based practice. Pediatr Clin North Am. Apr 2009;56(2):417-28. [Medline].)
The existence of significant dissociative psychopathology related to physical and sexual abuse experienced in childhood was known to clinicians in the last century. However, only recently have modern mental health practitioners begun to appreciate implications of this forgotten linkage.~ty (talk) 15:43, 5 August 2012 (UTC)

It's a useful source for basic information, much like a textbook, but it's not enough to over-write the more specific secondary sources that address specific points. For instance, you couldn't use it as a justification to eliminate all the iatrogenesis material, nor could you use its general info to contradict secondary sources. Looks like it would be useful for expanding mostly the traumagenesis position, but you're still better off using specific secondary sources whenever available. You could always take the question to the reliable sources noticeboard. WLU (t) (c) Wikipedia's rules:^simple/_complex 01:57, 5 August 2012 (UTC)

(edit conflict)

I'd say no.

Look at the references they list for the Medline article. Only a few deal with DID. Most refer generally to "dissociation" if they mention it at all. Many are on child abuse without mentioning dissociation. Many are on PTSD. Most are primary research. Many were done in the 1980s and 1990s. The article seems to confuse DID, dissociation, PTSD. There is a huge concentration on studies of child abuse but they don't have solid review articles linking it to DID. Many other problems with the references.

Look for yourself:

References

Shipman K, Taussig H. Mental health treatment of child abuse and neglect: the promise of evidence-based practice. Pediatr Clin North Am. Apr 2009;56(2):417-28. [Medline].

Cicchetti D, Lynch M. Toward an ecological/transactional model of community violence and child maltreatment: consequences for children's development]. Psychiatry. Feb 1993;56(1):96-118. [Medline].

Cicchetti D, Rogosch FA. Psychopathology as risk for adolescent substance use disorders: a developmental psychopathology perspective]. J Clin Child Psychol. Sep 1999;28(3):355-65. [Medline].

Kluft RP. Diagnosing multiple personality disorder. Pa Med. Sep 1984;87(9):44, 46. [Medline].

Kluft RP. An update on multiple personality disorder. Hosp Community Psychiatry. Apr 1987;38(4):363-73. [Medline].

Carmen EH, Rieker PP, Mills T. Victims of violence and psychiatric illness. Am J Psychiatry. Mar 1984;141(3):378-83. [Medline].

Richter JA, Serena A, Charvet MA, Virto R, Errasti P. Ureteral fistula after renal transplantation: the significance of delayed images. Eur J Nucl Med. 1984;9(9):436-7. [Medline].

Lauterbach D, Somer E, Dell P, Vondeylen H. Abuse history and pathological dissociation among Israeli and American college students: a comparative study. J Trauma Dissociation. 2008;9(1):51-62. [Medline].

Edwards VJ, Holden GW, Felitti VJ, Anda RF. Relationship between multiple forms of childhood maltreatment and adult mental health in community respondents: results from the adverse childhood experiences study. Am J Psychiatry. Aug 2003;160(8):1453-60. [Medline].

Wherry JN, Neil DA, Taylor TN. Pathological dissociation as measured by the child dissociative checklist. J Child Sex Abus. Jan-Feb 2009;18(1):93-102. [Medline].

Anderson SC, Bach CM, Griffith S. Psychosocial sequelae in intrafamilial victims of sexual assault and abuse. Amsterdam, Netherlands: April1981. Third international conference on child abuse and neglect.

Tuft's New England Medical Center, Division of Child Psychiatry. Sexually exploited children: Service and research project. Final report for the office of Juvenile Justice and Delinquency Prevention. Washington, DC: US Department of Justice; 1984.

Putnam FW, Guroff JJ, Silberman EK, Barban L, Post RM. The clinical phenomenology of multiple personality disorder: review of 100 recent cases. J Clin Psychiatry. Jun 1986;47(6):285-93. [Medline].

Middleton W, Butler J. Dissociative identity disorder: an Australian series. Aust N Z J Psychiatry. Dec 1998;32(6):794-804. [Medline].

Macfie J, Cicchetti D, Toth SL. The development of dissociation in maltreated preschool-aged children. Dev Psychopathol. Spring 2001;13(2):233-54. [Medline].

Howe ML, Toth SL, Cicchetti D. Can maltreated children inhibit true and false memories for emotional information?]. Child Dev. May-Jun 2011;82(3):967-81. [Medline].

Toth SL, Pickreign Stronach E, Rogosch FA, Caplan R, Cicchetti D. Illogical thinking and thought disorder in maltreated children. J Am Acad Child Adolesc Psychiatry. Jul 2011;50(7):659-68. [Medline].

Gast U, Rodewald F, Nickel V, Emrich HM. Prevalence of dissociative disorders among psychiatric inpatients in a German university clinic. J Nerv Ment Dis. Apr 2001;189(4):249-57. [Medline].

Sar V, Akyuz G, Kundakci T, Kiziltan E, Dogan O. Childhood trauma, dissociation, and psychiatric comorbidity in patients with conversion disorder. Am J Psychiatry. Dec 2004;161(12):2271-6. [Medline].

Hulette AC, Freyd JJ, Fisher PA. in middle childhood among foster children with early maltreatment experiences. Child Abuse Negl. Feb 2011;35(2):123-6. [Medline]. [Full Text].

Gutierrez Wang L, Cosden M, Bernal G. Dissociation as a mediator of posttraumatic symptoms in a Puerto Rican university sample. J Trauma Dissociation. 2011;12(4):358-74. [Medline].

Evren C, Sar V, Dalbudak E, Cetin R, Durkaya M, Evren B. Lifetime PTSD and quality of life among alcohol-dependent men: impact of childhood emotional abuse and dissociation. Psychiatry Res. Mar 30 2011;186(1):85-90. [Medline].

Tezcan E, Atmaca M, Kuloglu M, Gecici O, Buyukbayram A, Tutkun H. Dissociative disorders in Turkish inpatients with conversion disorder. Compr Psychiatry. Jul-Aug 2003;44(4):324-30. [Medline].

Foote B, Park J. Dissociative identity disorder and schizophrenia: differential diagnosis and theoretical issues. Curr Psychiatry Rep. Jun 2008;10(3):217-22. [Medline].

Allison RB. Multiple personality and criminal behavior. Am J Forensic Psychiatry. 1981;2:32-38.

Weber S. Treatment of trauma- and abuse-related dissociative symptom disorders in children and adolescents. J Child Adolesc Psychiatr Nurs. Feb 2009;22(1):2-6. [Medline].

Bierer LM, Yehuda R, Schmeidler J, et al. Abuse and neglect in childhood: relationship to personality disorder diagnoses. CNS Spectr. Oct 2003;8(10):737-54. [Medline].

Brown GR, Anderson B. morbidity in adult inpatients with childhood histories of sexual and physical abuse. Am J Psychiatry. Jan 1991;148(1):55-61. [Medline].

Brown RJ. Different types of "dissociation" have different psychological mechanisms. J Trauma Dissociation. 2006;7(4):7-28. [Medline].

Chu JA, Frey LM, Ganzel BL, Matthews JA. Memories of childhood abuse: dissociation, amnesia, and corroboration. Am J Psychiatry. May 1999;156(5):749-55. [Medline].

DeFrancis V. Protecting the Child Victim of Sex Crimes Committed by Adults. Denver, CO: Children's Division, American Humane Association; 1969.

Dorahy MJ, Lewis CA. Dissociative identity disorder in Northern Ireland: a survey of attitudes and experience among clinical psychologists and psychiatrists. J Nerv Ment Dis. Oct 2002;190(10):707-10. [Medline].

Ellason JW, Ross CA. Two-year follow-up of inpatients with dissociative identity disorder. Am J Psychiatry. Jun 1997;154(6):832-9. [Medline].

Foote B, Smolin Y, Kaplan M, Legatt ME, Lipschitz D. Prevalence of dissociative disorders in psychiatric outpatients. Am J Psychiatry. Apr 2006;163(4):623-9. [Medline].

Lewis DO, Yeager CA, Swica Y, Pincus JH, Lewis M. Objective documentation of child abuse and dissociation in 12 murderers with dissociative identity disorder. Am J Psychiatry. Dec 1997;154(12):1703-10. [Medline].

Putnam FW. Diagnosis and Treatment of Multiple Personality Disorder. New York, NY: Guilford Press; 1989.

Putnam FW. Ten-year research update review: child sexual abuse. J Am Acad Child Adolesc Psychiatry. Mar 2003;42(3):269-78. [Medline].

Sar V, Koyuncu A, Ozturk E, et al. Dissociative disorders in the psychiatric emergency ward. Gen Hosp Psychiatry. Jan-Feb 2007;29(1):45-50. [Medline].

Simeon D, Guralnik O, Schmeidler J, Sirof B, Knutelska M. The role of childhood interpersonal trauma in depersonalization disorder. Am J Psychiatry. Jul 2001;158(7):1027-33. [Medline].

Vogel M, Spitzer C, Kuwert P, Moller B, Freyberger HJ, Grabe HJ. Association of childhood neglect with adult dissociation in schizophrenic inpatients. Psychopathology. 2009;42(2):124-30. [Medline].

Wilbur CB. Multiple personality and child abuse. An overview]. Psychiatr Clin North Am. Mar 1984;7(1):3-7. [Medline].

Xiao Z, Yan H, Wang Z, et al. Trauma and dissociation in China. Am J Psychiatry. Aug 2006;163(8):1388-91. [Medline].

MathewTownsend (talk) 02:03, 5 August 2012 (UTC)

'Let me ask another question to all'. Is the Medscape sight normally considered to be a good reference for WP especially when it's been updated in 2011? It is getting to feel like what is normally accepted on WP is not here on the DID page for whatever reasons. If so, can someone explain please.~ty (talk) 15:36, 5 August 2012 (UTC)

Reply to Mathew - I am not seeing a problem with the references used by Medscape at all - Heck Kluft is considered THE number one expert in DID, trauma studies and child abuse studies are very much about DID if that is what they are looking at, F. Putman! Have you read his book!, Chu - same thing... read the book!, Sar is used often on this page.. I just don't see any problem at all with their citations.~ty (talk) 15:43, 5 August 2012 (UTC)

Reply to WLU - Thank you for this link WLU - reliable sources noticeboard I will look into this. Do you have secondary sources that can refute what Medscape says? Please present them or I will consider it that you do not. (as you keep doing) ~ty (talk) 15:43, 5 August 2012 (UTC)

reply to Tylas

So it doesn't bother you that most of the articles cited by Medscape for their article on DID were published in the 1980s and 1990s, don't mention DID, and are mostly about abuse of children? Except Kluft's 1987 article where he says "it is most parsimoniously understood as a chronic dissociative posttraumatic stress disorder, and that it has an excellent prognosis when intensive and prolonged psychotherapy with an experienced clinician is available."?

Have you read reliable sources for medical aritcles? MathewTownsend (talk) 17:10, 5 August 2012 (UTC)

Reply to Mathew - Not in the real world, this is how an article is wrote, and medscape is a respected sight. I will let this reference go for now - since I do respect your knowledge of WP.~ty (talk) 14:33, 6 August 2012 (UTC)

Note to Mathew - I have been adopted! I am willing to put in the time to make this article correct. Be patient with me please! I just started school today! ;) ~ty (talk) 15:14, 6 August 2012 (UTC)

Question for Mathew - I was looking at this site again, doing another project off WP and I was looking at the authors. Many work with children. Perhaps this is the reason for there being many articles linked to pediatrics. Could this not also be seen as those experts who understand children including DID? With this understanding does that not give more credit to the citations list - those are Experts on children looking at DID and how it affects children.

Article authors: Contributor Information and Disclosures Author

Muhammad Waseem, MD Associate Professor of Emergency Medicine in Clinical Pediatrics, Weill Medical College of Cornell University; Consulting Staff, Department of Pediatrics, Bronx Lebanon Hospital; Consulting Staff, Department of Emergency Medicine, Lincoln Medical and Mental Health Center

Muhammad Waseem, MD is a member of the following medical societies: American Academy of Pediatrics, American College of Emergency Physicians, American Heart Association, and American Medical Association

Disclosure: Nothing to disclose. Coauthor(s)

Muhammad Aslam, MD Instructor in Pediatrics, Harvard Medical School; Staff Physician, Department of Medicine, Division of Newborn Medicine, Children's Hospital Boston

Muhammad Aslam, MD is a member of the following medical societies: American Academy of Pediatrics, American Medical Association, American Medical Association, Massachusetts Medical Society, and Southern Medical Association