348 CHAPTER 8
Lewis, & Lewis, 1996) and also report having displayed signs of dissociation in
childhood (Lewis et al., 1997). Moreover these patients report that they either don’t
remember being abused or remember very little of it (Lewis et al., 1997; Swica,
Lewis, & Lewis, 1996). In addition, girls who were easy to hypnotize and able to
dissociate readily were found to be the ones most likely to have been abused physi-
cally or sexually (Putnam et al., 1995).
However, if the posttraumatic model is correct, there should be a signifi cant
number of cases of childhood DID. In fact, very few such cases have been docu-
mented, and most studies of abused children have found only a great ability to
dissociate,not the presence of alters (Piper & Merskey, 2004a). Moreover, most
studies of adults with DID who experienced childhood abuse have not obtained
independent corroborating evidence of abuse or trauma but rather rely solely on
the patient’s—or an alter’s—report of abuse during childhood (Piper & Merskey,
2004a, 2000b). As we saw in Chapter 5, self-reports are subject to various cogni-
tive biases. In short, mental health professionals are divided over whether childhood
trauma is the root cause of DID (Dell, 1988; Pope et al., 1999).The Sociocognitive Model In contrast to the posttraumatic model of DID, the
sociocognitive model proposes that social interactions between therapist and pa-
tient (social factor) foster DID by infl uencing the beliefs and expectations of the
patient (psychological factor). According to the sociocognitive model, the therapist
unintentionally causes the patient to act in ways that are consistent with the symp-
toms of DID (Lilienfeld et al., 1999; Sarbin, 1995; Spanos, 1994). This explanation
is plausible in part because hypnosis was commonly used to bring forth alters, and
researchers have pointed out that suggestible patients can unconsciously develop
alters (and ensuing neurological changes) in response to the therapist’s promptings
(Spanos, 1994). For instance, a therapist may encourage a patient to develop alters
by asking specifi c questions (“Have people come up to you who seem to know you,
but they are strangers to you?” or “Do you fi nd clothes in your closet that you
don’t remember purchasing?”) and then showing special interest when the patient
answers “yes” to any such question. One fi nding that supports the sociocognitive
model is that many people who have been diagnosed with DID had no notion of the
existence of any alters before they entered therapy (Lilienfeld et al., 1999). In addi-
tion, cultural cues regarding DID (such as in portrayals in movies and memoirs or
interviews of people with the disorder) may infl uence a patient’s behavior.The Debate About Dissociative Identity Disorder
After years of debate, the central issue regarding DID is not whether it exists, but
rather how it arises and continues (McHugh, 1993). Is DID a natural response to
severe and chronic childhood abuse, or is it mainly a product of infl uences from theDissociative identity disorder is described or
portrayed in various fi lms and memoirs; the
photo shown here is a publicity shot for one of
the earliest and best-known fi lms, The Three
Faces of Eve. According to the sociocognitive
model of this disorder, such media portrayals
can help create expectations in both patients
and therapists about how people with the
disorder behave. Therapists, in turn, uninten-
tionally reinforce patients for behaving in ways
consistent with such portrayals. 20thCentFox/Courtesy Everett Collection