Encyclopedia of Psychology and Law

generation and compartmentalization of multiple iden-

tities is manifested as an adaptive strategy that allows

the individual to cope with trauma. Consonant with

this theory, some DID patients report symptoms simi-

lar to those found in posttraumatic stress disorder,

such as nightmares, flashbacks, and increased startle

responses. The disease theory attributes the rise in

prevalence of DID to more accurate diagnoses by clin-

icians as a result of increased awareness of childhood

abuse and its psychiatric sequelae, greater acceptance

of the disorder, and a more in-depth focus on previ-

ously overlooked symptoms. According to this expla-

nation, certain physicians in specific cultures are

becoming sufficiently familiar with the disease to

accurately diagnose those symptoms of DID that pre-

viously went undiagnosed or misdiagnosed.

Critics of this disease model question the fidelity of

memories of abuse reported by DID patients. Such

reports are almost exclusively retrospective, and it has

been firmly established that childhood memories are

susceptible to distortion. In addition, critics suggest

that a belief in the disease model may lead clinicians

to specifically search for dissociative symptoms in

clients with a known history of abuse or for memories

of abuse in a client presenting dissociative symptoms,

inflating the correlation between DID and memories

of abuse. Techniques known to facilitate memory dis-

tortion, such as hypnosis, have been used by some

clinicians, resulting in questions about the validity of

uncovered memories of abuse and the existence of

alter identities. Often, memories of abuse are uncov-

ered in therapy, leading many to challenge the veridi-

cality of these memories and point to a theory of a

therapist-induced iatrogenic etiology.

An alternative perspective to the disease model,

termed the sociocognitive model, proposes that DID is

a socially influenced construction that is legitimized

and maintained through social interactions. According

to this theory, as the disorder has become more widely

accepted, DID patients have learned how to present

themselves as having multiple identities. Patients form

a belief as to how others expect them to act and behave

accordingly. This theory suggests that therapists play a

large role in the generation and maintenance of this

disorder through the use of suggestive questioning, the

provision of information about how patients with the

disorder should act, and the legitimization of the disor-

der. This sociocognitive perspective suggests an iatro-

genic etiology, proposing that the disorder is generated

by the client in response to the suggestive questioning

and expectations of the therapist. This view does not

assume that a DID patient is consciously faking symp-

toms but instead speculates that dissociative symptoms

are manifested as a way for individuals to view them-

selves in a way that is congruent with what they

believe is expected of them. Often a patient seeks ther-

apy to deal with unspecified psychological distress,

and the expression of dissociative symptoms can result

in a DID diagnosis, which may bring relief, explana-

tions, and the potential for treatment. Thus, symptoms

can be created and experienced by the patient as veridi-

cal in that DID patients interpret their normal life

experiences from the viewpoint of a fractionated self.

According to the sociocognitive model, an increase in

the popularity and social acceptance of the disorder

has led to greater manifestations of DID symptoms

by highly suggestible individuals. Supporting the

sociocognitive model, studies have found that alternate

personalities can be generated and maintained by indi-

viduals with no psychiatric history when undergoing

suggestive questioning.

Forensic Implications

Given the rising numbers of individuals diagnosed

with DID, it is no surprise that the controversy sur-

rounding DID has carried over into the courtroom.

DID diagnoses have been used as a defense for indi-

viduals charged with crimes including kidnapping,

forgery, drunk driving, and rape, with varying out-

comes. Defendants with DID have pleaded innocent

for crimes that they do not remember, purportedly

committed by other identities. These defense pleas

raise the question as to whether an individual can be

held legally responsible for a crime committed by

another alter not under the control of the dominant

identity. The validity of the DID diagnosis is central to

the debate over whether a DID patient should be con-

sidered as one unitary individual or as a conglomerate

of multiple identities and, in the latter case, whether

these distinct identities can be individually and disso-

ciably culpable of a crime. Inter-identity amnesia is

another important aspect of this debate, raising the

question of whether an individual can be held crimi-

nally responsible for a crime committed by another

identity of which he or she has no memory or aware-

ness. As demonstrated by the inconsistency in the

courtroom verdicts, this debate has not been resolved.

A DID diagnosis has additional ramifications for

the legal system. Legal suits have been brought

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