The imitation of dissociative identity disorder: Patients at risk, therapists at risk

Abstract

Since the late 1980s the authors have been confronted with cases of imitated dissociative identity disorder (DID) in Holland. Because DSM-IV defines 'factitious disorder' as intentional, the term 'imitation of DID' is used here for patients who, partly unconsciously motivated, simulate a DID profile. DID can be imitated due to contagion, to iatrogenesis, or to both. The core dynamics are: (1) the avoidance of responsibility for negative behavior, found mostly in patients with a borderline or antisocial personality disorder; and (2) the compensation for an overwhelming feeling of not being seen. The last, 'hysterical,' dynamic is characterized by identity disturbances varying in severity according to the underlying borderline personality structure. Four cases are described. Differentiating between genuine and imitated DID requires systematic assessment by an experienced clinician. Even then this is difficult, in particular differentiating between flamboyant genuine DID, with coexisting histrionic personality disorder (a minority of patients with genuine DID), and simulated cases. Diagnostic and treatment implications are discussed.