Sic et Non self deconstructs

[_Stem]

DrW's 1.3% figure for the incidence of DID is actually on the low end of what I've found from the first few online sources I checked. But doesn't it seem awfully high?

It's only smaller than the proportion of gay people by a factor of three or so, and there have been quite a few gay people in my own circles of family, friends, and acquaintances over the years. I'm not aware of ever having actually met someone with DID.

Okay, if someone had DID they might not be shouting about it to me. Still, though. The figure seems high for such a drastic condition. Something that affects 1.3% of the population is something which touches everyone: everyone will know someone who has it. Is that really the case for DID?

I know a number of people with DID. But for me its once you know one you meet many more. It's unbelievably devastating to watch people deal with it, and incredibly difficult when someone very close to you has it. Half the time you feel like the victim. The statistics do seem high though.

[_DrW]

DrW's 1.3% figure for the incidence of DID is actually on the low end of what I've found from the first few online sources I checked. But doesn't it seem awfully high?

It's only smaller than the proportion of gay people by a factor of three or so, and there have been quite a few gay people in my own circles of family, friends, and acquaintances over the years. I'm not aware of ever having actually met someone with DID.

Okay, if someone had DID they might not be shouting about it to me. Still, though. The figure seems high for such a drastic condition. Something that affects 1.3% of the population is something which touches everyone: everyone will know someone who has it. Is that really the case for DID?

DID is the most severe of several types of Dissociative Disorder as recognized in the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM5), and in the International Classification of Diseases (ICD-10). Others disorders in this classification include:

• Dissociative amnesia including Dissociative Fugue
• Depersonalization/Derealization disorder
• Other Specified Dissociative Disorder
• Unspecified Dissociative Disorder

When one realizes that the principal etiological factor in all of these disorders, as well as a frequently recognized contributing factor in other mental health disorders including some forms of schizophrenia and borderline personality disorder, is abuse and neglect of young children, the numbers may not seem so high. Also consider that estimates put the proportion of sufferers who seek clinical treatment at less than 10%.

It's no accident that most dissociative disorders, as well as other mental illnesses, become manifest in the early teens to twenties. Clinicians know that the abnormal changes in brain function associated with these disorders precede symptomatic changes in behavior by a decade or more. The same is true for onset of dementia later in life. Donald Trump, who had a distant mother and an overbearing authoritarian father as a young child, had to be sent to a military academy because of behavioral problems by age 13, has struggled intellectually his entire life, and is now a pathological liar who exhibits florid symptoms of narcissistic personality disorder and early stage dementia, serves as an example on both ends of the age spectrum.

Adults who abuse or neglect young children often rob these children of a normal productive life. More often than not, the abusers are not aware of the long term harm they do, and more often still the abusers are able to avoid any consequences for their actions.

[_Physics Guy]

If DID is more caused by adverse circumstances than by genetic lottery then maybe it is surprisingly prevalent in the whole population but strongly clustered, for example in places where childhood is frequently hard. That could explain why I've never knowingly met anyone with DID, even though I would have encountered a 1.3% condition many times in my life if it were evenly spread.

If there is clustering, though, then it could also be that some studies might have over-estimated the overall prevalence of DID by extrapolating from particular communities in which DID was actually more common than it is on average.

[_DrW]

If DID is more caused by adverse circumstances than by genetic lottery then maybe it is surprisingly prevalent in the whole population but strongly clustered, for example in places where childhood is frequently hard. That could explain why I've never knowingly met anyone with DID, even though I would have encountered a 1.3% condition many times in my life if it were evenly spread.

If there is clustering, though, then it could also be that some studies might have over-estimated the overall prevalence of DID by extrapolating from particular communities in which DID was actually more common than it is on average.

Physics Guy,

Here is a 2011 paper that has some bearing on your point about possible clusters: "Epidemiology of Dissociative Disorders: An Overview", by Vedat Sar.

Apologies in advance for extensively quoting the author. To your point regarding vulnerable populations or "clusters", the author cites sex workers and teenagers as cohorts with a higher risk of dissociative disorders.

Exotic dancers and women in prostitution have also been demonstrated as risk groups for dissociative disorders. This seems to be due to the highly traumatic background of the probands. Studies on adolescents also yielded dissociation scores higher than those obtained in adult populations. This may occur due to elevated tendency to dissociation in early years of life.

Not surprisingly, substance abuse or being in psychiatric treatment are also associated with higher prevalence of dissociative disorders.

Overall, the prevalence of dissociative disorders in inpatient and outpatient psychiatric settings seems to be around 10%, while approximately half of them (5%) has DID, the most severe type of dissociative disorders.

As seen from the review, international comparisons regarding the prevalence of DID are hard to come by because of lack of reliable data. Comparative data in the paper are mainly from within country, and more specifically, within the populations already under some type of mental health care.

I note that the conclusions of the review author regarding the need for greater awareness of the effects of early childhood abuse and neglect on society in general were much the same as those I expressed upthread.

Last but not least, due to their link to early-life stress in the form of childhood abuse and neglect, better recognition of dissociative disorders would be of historical value for all humanity including global awareness about and prevention of adverse childhood experiences and their lifelong clinical consequences.