Amnesia was replaced when it became clear that the risk of false negative diagnoses was low because amnesia was central to DID.

While children have been diagnosed with DID before therapy, several were presented to clinicians by parents who were themselves diagnosed with DID ; others were influenced by the appearance of DID in popular culture or due to a diagnosis of psychosis due to hearing voices — a symptom also found in DID.

The popular association of DID with childhood abuse is relatively recent, occurring only after the publication of Sybil in 1973.

Despite its rareness, DID is portrayed with remarkable frequency in popular culture, producing or appearing in numerous books, films and television shows.

DID is one of the most controversial psychiatric disorders with no clear consensus regarding its diagnosis or treatment.

The symptoms of dissociative amnesia, dissociative fugue and depersonalization disorder are subsumed under DID diagnosis and are not diagnosed separately.

The large number of symptoms presented by individuals diagnosed with DID has led to some clinicians suggesting that, rather than being a separate disorder, diagnosis of DID is actually an indication of the severity of the other disorders diagnosed in the patient.

Their conclusions about the empirical proof of DID were echoed by a second group, who still believed the diagnosis existed, but while the knowledge to date did not justify DID as a separate diagnosis, it also did not disprove its existence.

Steven Lynn and colleagues have suggested that the significant overlap between BPD and DID may be a contributing factor to the development of iatrogenic DID, in that hidden alters suggested by therapists who propose a diagnosis of DID provides an explanation to patients for the behavioral instability, self-mutilation, unpredictable mood changes and actions.

Proponents of the SCM note that the bizarre dissociative symptoms are rarely present before intensive therapy by specialists in the treatment of DID who, through the process of eliciting, conversing and identifying alters, shape, or possibly create the diagnosis.

Other arguments for the iatrogenic position, include the lack of children diagnosed with DID, the sudden spike in incidence after 1980 ( although DID was not a diagnosis until DSM-IV, published in 1994 ), the absence of evidence of increased rates of child abuse, the appearance of the disorder almost exclusively in individuals undergoing psychotherapy, particularly involving hypnosis, the presences of bizarre alternate identities ( such as those claiming to be animals or mythological creatures ) and an increase in the number of alternate identities over time ( as well as an initial increase in their number as psychotherapy begins in DID-oriented therapy.

Proponents of the iatrogenic position suggest a small number of clinicians diagnosing a disproportionate number of cases would provide evidence for their position though it has also been claimed that higher rates of diagnosis in specific countries like the United States, may be due to greater awareness of DID.

A diagnosis of DID takes precedence over any other dissociative disorders.

Individuals faking or mimicking DID due to factitious disorder will exaggerate symptoms ( particularly when observed ), lie, blame bad behavior on symptoms and often show little distress regarding their apparent diagnosis.

Arguments have been made for allowing diagnosis through the presence of some, but not all of the characteristics of DID rather than the current exclusive focus on the two least common and noticeable features.

Psychiatrists August Piper and Harold Merskey have challenged the trauma hypothesis, arguing that correlation does not imply causation-the fact that people with DID report childhood trauma does not mean trauma causes DID — and point to the rareness of the diagnosis before 1980 as well as a failure to find DID as an outcome in longitudinal studies of traumatized children.

Dissociative identity disorder ( DID ), also known as multiple personality disorder, is a mental disorder characterized by at least two distinct and relatively enduring identities or dissociated personality states that alternately control a person's behavior, and is accompanied by memory impairment for important information not explained by ordinary forgetfulness.

Although neither epidemiological surveys nor longitudinal studies have been done, it is thought DID rarely resolves spontaneously.

There is little systematic data on the prevalence of DID.

DID is diagnosed more frequently in North America than in the rest of the world, and is three to nine times more common in females than in males.

An alternative hypothesis for the etiology of DID is as a product of techniques employed by some therapists, especially those using hypnosis, and disagreement between the two positions is characterized by intense debate.

The unusual number of diagnoses after 1980, clustered around a small number of clinicians and the suggestibility characteristic of those with DID, support the hypothesis that DID is therapist-induced.

The most widely used model of dissociation conceptualizes DID as at one extreme of a continuum of dissociation, with flow at the other end, though this model is being challenged.

According to this hypothesis, primary dissociation involves one ANP and one EP, while secondary dissociation involves one ANP and several EPs and tertiary dissociation, which is unique to DID, is described as having several of each.

Others have suggested dissociation can be separated into two distinct forms, detachment and compartmentalization, the latter of which, involving a failure to control normally controllable processes or actions, is most evident in DID.

According to the Diagnostic and Statistical Manual of Mental Disorders ( DSM ), DID includes " the presence of two or more distinct identities or personality states " that alternate control of the individual's behavior, accompanied by the inability to recall personal information beyond what is expected through normal forgetfulness.

The majority of patients with DID report childhood sexual and / or physical abuse, though the accuracy of these reports is controversial.

The most common presenting complaint of DID is depression, with headaches being a common neurological symptom.

The cause of DID is controversial, with debate occurring between supporters of different hypotheses: that DID is a reaction to the trauma ; that DID is produced iatrogenically by inappropriate psychotherapeutic techniques that cause a patient to enact the role of a patient DID ; and newer hypotheses involving memory processing that allows for the possibility that trauma-causing dissociation can occur after childhood in DID as it does in PTSD.

They assert that DID cannot be accurately diagnosed because of vague and unclear diagnostic criteria in the DSM and undefined concepts such as " personality state " and " identities ", and question the evidence for childhood abuse beyond self-reports, the lack of definition of what would indicate a threshold of abuse sufficient to induce DID and the extremely small number of cases of children diagnosed with DID despite an average age of appearance of the first alter of three years.

Distinguishing DID from malingering is a concern when financial or legal gains are an issue, and factitious disorder may also be considered if there patient has a history of help or attention seeking.

DID must be distinguished from, or determined if comorbid with, a variety of disorders including mood disorders, psychosis, anxiety disorders, posttraumatic stress disorder, personality disorders, cognitive disorders, neurological disorders, epilepsy, somatoform disorder, factitious disorder, malingering, other dissociative disorders and trance states.

The crux of this debate is if DID is the result of childhood trauma and disorganized attachment.

Others explain the increase as being due to the use of inappropriate therapeutic techniques in highly suggestible individuals, though this is itself controversial while proponents of DID claim the increase in incidence is due to increased recognition of and ability to recognize the disorder.

The DSM does not provide an estimate of incidence for DID and dissociative disorders were excluded from the Epidemiological Catchment Area Project.

As a result, there are no national statistics for incidence and prevalence of DID in the United States.

A majority of those diagnosed with DID meet the criteria for DSM axis II personality disorders such as borderline personality disorder ; a significant minority meet the criteria for avoidant personality disorder and other personality disorders.

In 1993 a group of researchers reviewed both DID and borderline personality disorder ( BPD ), concluding that DID was an epiphenomenon of BPD, with no tests or clinical description capable of distinguishing between the two.

The debates over the causes of DID also extend to disagreements over how the disorder is assessed and treated.

What may be expressed as posttraumatic stress disorder in adults may become DID when occurring in children, possibly due to their greater use of imagination as a form of coping.

) These various cultural and therapeutic causes occur within a context of pre-existing psychopathology, notably borderline personality disorder, which is commonly co-morbid with DID.

Individuals who state that their symptoms are due to external spirits or entities entering their bodies are generally diagnosed with dissociative disorder not otherwise specified rather than DID due to the lack of identities or personality states.

A specific relationship between DID and borderline personality disorder has been posited several times, with various clinicians noting significant overlap between symptoms and patient behaviors and it has been suggested that DID may arise " from a substrate of borderline traits.

" Reviews of DID patients and their medical records concluded that the majority of those diagnosed with DID would also meet the criteria for either borderline personality disorder or more generally borderline personality.