Who done it, actually? Dissociative identity disorder for the criminologist

Through the analysis of clinical examples, the paper explores how decisions are made by a person with Dissociative Identity Disorder (DID), the notions of choice and ‘competent reasoning’, and the practical and ethical ways for interviewing a person with DID. Abstract Dissociative Identity Disorder (DID) is examined in this paper from the perspective of its relevance to the criminologist. As this psychiatric condition is linked to severe and prolonged childhood abuse, accounts of DID patients inevitably involve reports of serious crimes, in which the person was the victim, perpetrator or witness. These reports can thus contain crucial information for criminal investigations by the police or for court proceedings. However, due to the person’s dissociation, such reports are often very confusing, hard to follow, hard to believe and difficult to obtain. They also frequently state that the person had ‘no choice’, a thorny notion for the criminologist (as well as for the clinician). Through the analysis of clinical examples, the paper explores how decisions are made by a person with DID, the notions of choice and ‘competent reasoning’, and the practical and ethical ways for interviewing a person with DID

The abused and the abuser(s): attachment relationship in dissociative identity disorder

This thesis aims to draw a unified picture of the relationship between Dissociative Identity Disorder (DID) (APA, DSM-5, 2013), the affected person’s attachment pattern, and specific characteristics of their trauma history. In particular, the analysis of these three elements focuses on cases where a person is persistently involved in a life of ongoing abuse, despite years of DID-specific psychotherapy. Based on attachment, forensic and psychoanalytic perspectives and on my extensive clinical work, I propose several new classifications to help identify and explain such cases, and ultimately improve their treatment. The first is further classification of the Disorganized Attachment (DA) category of attachment theory, to include two new sub-types: Concrete Infanticidal Attachment (IAc), which develops when a child needs to engage an attachment figure who only responds while the child is being severely abused, and Symbolic Infanticidal Attachment (IAs), which develops in response to severe but not abusive relational trauma, such as neglect. The second proposes a differentiation between two presentations of DID, Active and Stable. The first describes people who continue to be involved in a life of abuse even in adulthood, and their DID is thus constantly reinforced and recreated. The second pertains to people who bear the scars of childhood relational trauma but are safe at present and can focus on recovery from their traumatic past. Finally, I propose the Cyclical Model, which describes the relationship between severe childhood abuse, IAc and active DID as a self-perpetuating cycle. The term cyclicity is used to describe a repetitive, change-resisting quality of people with active DID. Cyclicity is attributed to their extreme levels of anxiety and terror. I argue that this quality, while ‘quiet’ and hard to detect, forms a major obstacle to recovery. Following these ideas, additional theoretical and clinical considerations are suggested as expansion to the Phase-Oriented Approach for the treatment of DID (ISSTD 2011). Key words: active DID, stable DID, attachment theory, childhood abuse, cyclicity, infanticidal attachment, relational trauma, phase-oriented treatment approach