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Hello, this is Dr. Grande.
Today's question asks if I can offer a critique of this video that was released by Trisha Paytas
talking about Dissociative Identity Disorder.
I'll refer to this disorder as DID.
An important note here: Trisha Paytas is, of course, a real person, so I'm not diagnosing anybody in this video.
I'm only speculating about what could be happening in a situation like this.
In this video, we see that Trisha Paytas is discussing how she self-diagnosed with two disorders:
Multiple Personality Disorder and Dissociative Identity Disorder.
Trisha is popular on YouTube.
I'm not exactly sure what she does,
and I've never actually watched any of her videos until this video on DID.
I also watched the video she released after this.
I'm accustomed to addressing fairly technical mental health topics
and offering critiques of opinions or positions that have some elements that are correct,
and some elements that may be a bit off.
I realize that Trisha is not running a channel about mental health or scientific evidence or anything like that.
However, if a content creator is going to talk about
a topic that can impact  how people understand mental health,
it would seem there's a basic responsibility to read something,
look for credible sources for information before making a video,
and to interpret information correctly.
But that's just my opinion.
As I offer a critique of this video, it would actually be easier to talk about what was correct,
as opposed to what was unclear or incorrect.
But either way, it was actually quite painful to watch,
and disturbing in terms of the impact it could have on people looking for information about  DID.
First I'll give a summary here of DID and look at the arguments around the disorder,
and then critique the specific video released by Trisha Paytas on DID.
I can't think of another mental disorder more controversial than Dissociative Identity Disorder.
There are many arguments in favor of the disorder being an actual disorder,
and arguments saying that it doesn't exist - and I'll talk about that in a few moments.
Looking for the definition of the disorder from the DSM,
I'l go through the quick version here,
we see a disruption of identity characterized by two or more distinct personality states.
Sometimes these states are referred to as "alters".
These alters may have different perceptions, memories, behavior, and thinking.
The most important part of these particular criterion is the use of the term "personality states"
and not the term "personality".
We're really not talking about additional personalities, but rather personality states.
The next criterion has to do with amnesia.
We see gaps in recall of everyday events and gaps in recall for traumatic events.
This is a critical part of DID.
This is actually used when trying to detect people who are faking the disorder.
People who are faking DID often talk about alters, but fail to report amnesia.
The last criterion I'll cover is what's referred to as "clinically significant distress".
If somebody has the symptoms of DID but it's not really causing dysfunction,
they wouldn't be diagnosed with the disorder.
This is another key criterion that is used to distinguish people who actually have it from people who are faking the disorder.
That's the defintion, let's take a look at the quick history of the disorder.
It's actually fairly interesting how this disorder developed.
We see that DSM1, the Diagnostic and Statistical Manual Version 1, that was published in 1952,
featured what was referred to as "Dissociated" or "Multiple" personality.
DSM2, released in 1968, featured "Hysterical Neurosis Dissociative Type".
DSM3, which came out in 1980, had the first use of "Multiple Personality Disorder".
And then, 14 years later with the DSM4, we see that category is changed to "Dissociative Identity Disorder".
Of course, it was maintained in DSM5, which was published in 2013.
So why do we see this change from "Multiple Personality Disorder" to DID?
Well, originally the disorder was conceptualized has somebody having "too many" personalities:
one is optimal, and more than one is likely to lead to problems.
Now it's conceptualized as a lack of a single unified identity, not the presence of multiple identities.
So that's kind of the history of the disorder.
Now moving to the some of the controversy behind the disorder:
As I mentioned, there are a lot of arguments here that go both ways.
I'm going to look at two popular schools of thought, and really, both of these arguments are actually expansive,
so I'm just providing a few key points from each side.
One side is what's called "iatrogenic".
This is the theory that this disorder is caused by counselors, or whoever is treating the client.
The other argument is sociocultural.
Essentially, this says that DID is a real disorder caused by trauma.
On the iatrogenic side, a few key point towards this argument:
a very small number of people clinicians diagnose the vast majority of people who have DID.
This could be explained, in part, by saying,
"These clinicians specialize in trauma, so they're going to see more cases of DID."
But it's a very small number and a very large portion of the people with the disorder.
This definitely weighs in favor of the iatrogenic thinking.
Studies have shown that on chart review, up to 70% of people diagnosed with DID
could have been diagnosed with Borderline Personality Disorder instead,
and up to 24% of people with Borderline Personality Disorder meet the criteria for DID.
This disorder became extremely popular after it was defined.
It's thought that the definition was influenced by a book called "Syble", which was published in 1973.
This was about an individual who allegedly had DID.
It turns out they really didn't have DID.
So it's thought that this book, again, led to the disorder being defined in DSM3 in 1980.
It may have been defined for a reason that turned out not to be a reason at all.
Another point: alters seem to be able to learn from information presented to another alter,
which runs against the fundamental theory behind DID.
This is referred to as "inter-identity transfer of information".
If there's amnesia, then the alters should not be able to know what other alters would remember
or what other alters would have learned.
This has been backed off of a little bit.
We see that there're researchers saying, "No, DID isn't really complete amnesia; it could be partial amnesia."
Either way, in the formation of the disorder, this was actually fairly critical,
so I think this point more to the iatrogenic side.
The last point I'll cover here, in terms of the iatrogenic side,
is there's always going to be a fascination with a rare disorder.
This is in every discipline. When you see something unusual, you pay more attention to it.
Counselors are not immune from this phenomenon.
How about the other side of the argument?
That this is socialcultural? That it is created from trauma?
DID, in this argument, becomes a way that the unconscious mind can protect itself from a trauma.
The mind kind of splits in to these personality "states" - it fragments,
and all these personalities are now incomplete.
None of them have the whole picture of what the person has experienced and learned.
Interestingly, the concept behind this dissociation is really not that controversial.
Most practitioners acknowledge that dissociation is real.
It's the leap over to the dissociative identity states that is challenging for some clinicians.
The trauma argument, again, is fairly straightforward:
Trauma leads to DID, and it leads to it through the mechanism of dissociation,
a well-established occurrence with trauma.
So what are my thoughts on this particular subject? My position on the idea that DID does or does not exist?
Its legitimacy as a classification?
Well, my position is that the symptoms do tend to cluster together in a small number of people.
But I would argue that it's likely that DID is probably overdiagnosed.
Dissociation, as I mentioned, is real. I do believe that happens.
I've seen that several times, and it's well-supported in the literature.
I think the disorder represents the difficulty with the wide variety of symptoms we see associated with trauma.
Trauma is definitely devastating to a lot of people.
People who have experienced it often need treatment
regardless of how those symptoms are grouped together in official mental disorder definitions.
The bottom line is that if somebody has the symptoms of DID, it really doesn't matter if the disorder is real or not.
They need treatment for those symptoms.
DID is just one way to arrange the symptoms.
One could argue that Borderline Personality Disorder, Post-Traumatic Stress Disorder,
and Depersonalization Derealization Disorder are all simply ways that we put symptoms together
to try to understand what people are going through and develop treatment protocols for those symptoms.
People who have DID symptoms are not to blame
for the way that mental health clinicians have decided to classify the disorder.
And they're not to blame for counselors who take things too far.
Counselors that suggest that other personalities may be at work when perhaps they're not in many of the cases.
The mental health community is so divided on this issue. We see pointing of fingers going on quite often.
People that believe the disorder is real look at the skeptics and say the skeptics are highly irresponsible,
and that they're causing major destruction for people with the disorder.
Then we see the skeptics on the other side, looking at those who believe in DID and saying,
"Classifying that as a real disorder, making it seem real when it's not,
is causing tremendous harm for people who have symptoms."
So we see a lot of finger pointing, a lot of blame to go around here as we try to figure out
what this classification really should be.
I would like to believe that most counselors or simply trying to find out the truth, whatever that is.
But we know, in the real world, it doesn't always work that way.
Now looking at this video by Trisha Paytas:
I'm going to go through this video item by item and point out what didn't make sense to me,
in terms of what we see in the scientific literature, and from my clinical experience.
This first point here, in this video we see that Trisha is self-diagnosing.
I can stop it right there.
This is always a bad idea.
It's not just the lack of technical knowledge that makes this a bad idea, it's the lack of perspective.
Sometimes it is a good idea to have a professional, who is objective and has proper training,
looking at one's situation to determine what's going on.
It kind of bypasses the lack of insight component that we sometimes see with mental disorders.
The next point builds on this self-diagnosis statement:
We see here that Trisha diagnosed herself with both Multiple Personality Disorder and Dissociative Identity Disorder,
indicating that there are some differences.
In the next video she did, she really doubled down on this idea that these are two different disorders.
I think this is really one of the most controversial statements she made,
because a lot of people have opinions about this statement.
But to be clear here: they are technically two different disorders.
One is no longer a diagnosable disorder - Multiple Personality Disorder is gone.
Again, it was banned when the DSM4 was published in 1994.
DID was the replacement for Multiple Personality Disorder, and DID is a bit different.
For example, it expanded amnesia to everyday events and not just areas around trauma.
It's a little bit like Hypochondriasis and Somatic Symptom Disorder.
Yes, they are two different disorders technically,
but somebody wouldn't be diagnosed with both, because the former is no longer diagnosable.
This kind of show that maybe she didn't understand that DID was the replacement for Multiple Personality Disorder.
It didn't add to it. Both are out there for eligible diagnosis.
The next point: Trisha indicates that dissociating comes in different forms than the alters.
The current conceptualization of the alters is that they are dissociative states,
so I'm not really sure what she's talking about here.
It seems clear that she's trying to describe something, it's just impossible to know what that is.
There wouldn't be alters without dissociation. It's literally in the name: Dissociative Identity Disorder.
It's a key part of the disorder.
The next point is just something I found interesting, it's not particularly important.
When she said she didn't want to scare people, I thought to myself "too late". That just popped in my head.
It's not the DID that's scary, it's the lack of knowledge that we see expressed here that's downright frightening.
Next point: Trisha indicates that the alters are assisting the primary personality which she refers to as "Trish".
I guess that's because that's her name, that makes sense.
It's almost like she's describing the alters like they get together and have meetings.
Like they're on a committee or something, I don't know know.
I've never seen alters described that way.
Alters aren't enjoyable.
They're not usually conceptualized as "helpful",
like they come in and get together and advise the primary personality.
That's just an unusual description of DID alters.
The next point: Trish, in a sense, holds the alters responsible for some of her behavior.
I'm not judging the behavior, I'm simply noting what she's saying in a situation.
She says that the alters have cuased failed relationships.
She says that one of the alters can't stop eating.
This type of characterization is really one the criticisms that researchers have of the construct of DID.
Allowing somebody to place blame on an alternate personality.
This may be her experience - I'm not saying this isn't happening to her.
I'm just pointing out how some may react to this type of characterization.
Trish indicates that she doesn't consider the DID to be a problem or an issue.
She says maybe it's just her imagination, and she's being creative.
By definition, DID does cause clinically significant distress. I talked about that before.
In her follow-up video, to be fair, she does portray her experiences as much more distressing.
I'm not sure why that wasn't mentioned in the first video, but either way, she does say that later on.
My last thought here: generally, in this video, we just see kind of a stream of consciousness.
It's impressionistic, like talking about something without any detail.
Just talking in a seemingly random and disorganized way.
I don't think this is very useful. I guess it has some entertainment value - I'm not really sure.
But it certainly doesn't have any educational value.
One example of this, we see that Trish refers to her primary personality
as "dissociating the most without dissociating, if that makes sense."
That's what she says.
Nothing about that makes sense.
So, to sum up my thoughts on the video.
On one hand, one could argue that this is a video of a young woman talking about her personal experiences.
She does use some of the technical terminology inaccurately,
but she wasn't representing this as a scientific discussion in her video.
She didn't frame her video as educational.
On the other hand, I do feel that content creators need to exercise more caution
when straying into areas where they lack knowledge.
Essentially I think about this in two ways: signal to noise ratio and accuracy.
With signal to noise, if you're talking on a cellphone, what somebody says - their words - would be the signal,
and the static would be the noise.
You want to hear the signal - you want to hear the message,
and the more static there is, the harder is becomes to hear that message.
This video by Trisha has a lot of noise.
The other element is the signal accuracy.
If you can hear the signal - if you can get past the noise - is the signal actually giving you useful information?
In this video published by Trisha Paytas, I don't see where there's a lot of accuracy.
So we see two major problems in terms of communicating information.
There was one positive thing that I think came from this video, and that is that it really highlighted DID.
It's brought this into a more popular discussion.
I think that's one of the positive elements I see a lot of times when kind of popular
YouTube content creators venture into the area of mental health.
I may not like that lack of technical accuracy, but I am happy it's being brought into the wider discussion.
I know whenever I talk about topics like DID there will be a variety of opinions.
Please put any opinions and thoughts in the comments section; they always generate an interesting dialogue.
As always, I hope that you found my analysis of this topic to be intersting.
Thanks for watching.
