DSM-5 (post 2): Order of diagnostic criteria for dissociative identity disorder (multiple personality) contributes to skepticism, but what causes emotional skepticism?

In my previous post, I explained why the order of the diagnostic criteria in DSM-5—multiplicity first and memory gaps second—prevents most clinicians from ever making this diagnosis (because that order is the opposite of how the diagnosis is usually made in clinical practice).

Another result is skepticism. Headlining the multiplicity makes people imagine that patients come to psychiatrists complaining of multiplicity; or, that psychiatrists project the idea of multiplicity onto patients. But those things rarely happen, because most patients with multiple personality don’t know they have it (and, anyway, don’t want that diagnosis), and because that is not how psychiatrists usually come to make the diagnosis (and we are too busy to go on wild-goose chases).

In most cases, the first step in making the diagnosis is a single screening question that makes no reference to multiple personality. It is a slight modification of the routine evaluation of memory. In addition to evaluating 1. immediate and short-term memory, and 2. long-term memory, the psychiatrist asks, “Do you ever have memory gaps or lose time?” Most patients will say, “No,” and that is that.

I remember the first time that I asked a patient that question and got a positive answer: I was shocked! Nothing in my formal psychiatric training had led me to ask that question or expect that answer.

So I think that the order of the diagnostic criteria, and its contribution to a misconception about how multiple personality is usually diagnosed, is one factor in skepticism. But why are some people emotionally and irrationally skeptical? I had been skeptical before making the diagnosis, but it was not something I had gotten emotional about. It was something I had mostly ignored.

Now that I know, from my reading since 2013 for this blog, that there is a normal version of multiple personality, I wonder if some of the emotional skeptics have the normal version, are in denial, and doth protest too much.