welcome to my scientifically informed
insider look at mental health topics if
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my channel closest doctor grande today's
question asks if I can offer a critique
of this video that was released by
Trisha Paytas talking about dissociative
identity disorder as di D an important
note here Trisha Paytas of course is a
real person so I'm not diagnosing
anybody in this video I'm only
speculating about what could be
happening a situation like this so in
this video we see that Trisha Paytas is
discussing how she self diagnosed with
two disorders multiple personality
disorder and dissociative identity
Trisha is popular on YouTube I'm not
exactly sure what she does and I've
never actually watched any of her videos
until this video one D ID and I also
watched the video she released after
this I'm accustomed to addressing fairly
technical mental health topics and
offering critiques of opinions or
positions to have some elements that are
correct and some elements that may be a
bit off now I realize that Trisha is not
running a channel about mental health or
scientific evidence or anything like
that however if a content creator is
going to talk about a topic that can
impact how people understand mental
health it would seem there's a basic
responsibility to read something look
for credible sources for information
before making a video and to interpret
information correctly but that's just my
opinion as well for a critique of this
video would actually be easier to talk
about what was correct as opposed to
what was unclear or incorrect but either
way it was actually quite painful to
watch and disturbing in terms of the
impact it could have on people looking
for information about di D so first I'll
give a summary here of di D and look at
the arguments around the disorder and
then critique the specific video
released by Trisha Paytas on di D I
can't think of another mental disorder
more controversial than the sociated by
dinosaur there are many arguments in
favor of the disorder being an actual
disorder and arguments saying that it
doesn't exist and I'll talk about that
in a few moments looking at the
definition
of the disorder from the DSM I'll go
through the quick version here we see a
disruption of identity characterized by
two or more distinct personality states
sometimes these states are referred to
as altars these altars may have
different perceptions memories behavior
and thinking the most important part of
this particular criterion is the use of
the term personality States and not the
term personality so we're really not
talking about additional personalities
rather personality States now the next
criterion has to do with amnesia we see
gaps in recall of everyday events and
gaps in recall for traumatic events so
this is a critical part of di D this is
actually used when trying to detect
individuals who are faking the disorder
people who are faking about di D often
talk about altars but fail to report
amnesia the last criterion I'll cover is
what's referred to as clinically
significant distress so if somebody has
the symptoms of di D but it's not really
causing dysfunction they wouldn't be
diagnosed with the disorder this is
another key criterion that is used to
distinguish people who actually have it
from people who are faking the disorder
so now that's the definition let's take
a look at the quick history of the
disorder is actually fairly interesting
how this disorder developed we see the
DSM 1 the Diagnostic and Statistical
Manual version 1 that was published in
1952 featured what was referred to as
the Associated or multiple personality
DSM - released in 1968 featured
hysterical neurosis dissociative type
DSM 3 which came out in 1980 had the
first use of multiple personality
disorder and then 14 years later with
the sm4 we see that categories changed
to dissociative identity disorder and of
course it was maintained in dsm-5 which
was published in 2013 so why do we see
this change from multiple personality
disorder to D ID well originally the
disorder was conceptualized as somebody
having too many personalities right so
one is optimal and more than one is
likely to lead to problems
now it's conceptualized as a lack of a
sin
unified identity not the presence of
multiple identities so that's kind of
the history of disorder so now moving to
some of the controversy behind the
disorder so as I mentioned there are a
lot of arguments here both ways I'm
going to look at two popular schools of
thought and really both of these
arguments are actually expansive so I'm
just providing a few key points from
each side one side is what's called
iatrogenic this is the theory that this
disorder is caused by counselors or
whoever's treating a client the other
argument is socio-cultural so
essentially this says that the ID is a
real disorder caused by trauma
so on the iatrogenic side a few key
points toward this argument a very small
number of clinicians diagnosed the vast
majority of people who have D ID now
this could be explained in part by
saying okay these clinicians specialize
in trauma so they're gonna see more
cases of D ID but it's a very small
number and a very large proportion of
the people with the disorder right so
this definitely weighs in favor of the
iatrogenic thinking studies have shown
that upon chart review up to 70% of
people diagnosed with the ID could have
been diagnosed with borderline
personality disorder instead and up to
24% of people with borderline
personality disorder meet the criteria
for D ID this disorder became extremely
popular after it was defined it's
thought that the definition was
influenced by a book called Sybil which
was published in 1973 this was about an
individual who allegedly had the ID it
turns out they really didn't have the ID
so it's thought that this book again led
to the disorder being defined in DSM 3
in 1980 so it may have been defined for
a reason that turned out not to be a
reason at all another point alters seem
to be able to learn from information
presented to another alter which runs
against the fundamental theory behind
the ID this is referred to as the intern
identity transfer of information right
so if there's amnesia
then the alters should not be able to
know what other alters would remember
or what other alters would
have learned now this has been backed
off of a little bit like we see that
there's researchers are saying no di D
isn't really complete amnesia
it could be partial amnesia but either
way and the formation of the disorder
this was actually fairly critical so I
think this points more toward the
iatrogenic side and the last point I'll
cover here in terms of the iatrogenic
side is there's always going to be a
fascination with a rare disorder right
so this is in every discipline when you
see something unusual you pay more
attention to it and counsellors are not
immune from this phenomenon now how
about the other side of the argument
that this is socio-cultural that it's
created from trauma
well the ID this argument becomes a way
that the unconscious mind can protect
itself from a trauma right so the mind
kind of splits in two these personality
states it fragments and all these
personalities are now incomplete none of
them have the whole picture of what the
person has experienced and learned so
interestingly the concept behind this
dissociation is really not that
controversial most practitioners
acknowledge that dissociation is real
it's the leap over to the dissociative
identity states that is challenging for
some clinicians so the trauma argument
again is fairly straightforward trauma
leads to di D and it leads to it through
the mechanism of dissociation a
well-established
occurrence with trauma so what are my
thoughts on this particular subject my
position on the idea that the ID does or
does not exist its legitimacy as a
classification well my position is that
the symptoms do tend to cluster together
in a small number of people but I would
argue that it's likely the D ID is
probably over diagnosed the Association
as I mentioned is real I do believe that
happens I've seen that several times
and it's well supported in the
literature I think the disorder
represents the difficulty with the wide
variety of symptoms we see associated
with trauma trauma is definitely
devastating to a lot of people people
that have experienced it often need
treatment regardless of how those
symptoms are grouped together in
official mental disorder definitions so
the bottom line is that if somebody has
the symptoms of di D it really doesn't
matter if the disorder is real or not
they need treatment for those symptoms
the idea is just one way to arrange the
symptoms one could argue that borderline
personality disorder post-traumatic
stress disorder and deep personalization
derealization disorder or all simply
ways that we put symptoms together to
try to understand what people are going
through and develop treatment protocols
for those symptoms so people who have
the ID symptoms are not to blame for the
way that mental health clinicians have
decided to classify the disorder and
they're not to blame for counselors who
take things too far
counselors that suggests that other
personalities may be at work when
perhaps they're not and again many of
the cases the mental health community is
so divided on this issue we see pointing
of fingers going on quite often right so
people that believe the disorder is real
look at the skeptics and say the
skeptics are highly irresponsible and
they're causing major destruction for
people with the disorder then we see the
skeptics on the other side looking at
those who believe in the ID and saying
classifying that as a real disorder
making it seem real when it's not is
causing tremendous harm for people who
have symptoms so we see a lot of
finger-pointing a lot of blame to go
around here as we try to figure out what
this classification really should be I
would like to believe that most
counselors are simply trying to find out
the truth
whatever that is right but we know in
the real world it doesn't always work
that way so now looking at this video by
Trisha Paytas so I'm going to go through
this video
item by item and point out what didn't
make sense to me in terms of what we see
in the scientific literature and from my
clinical experience so the first point
here in this video we see that Trisha is
self diagnosing so I can stop it right
there this is always a bad idea it's not
just a lack of technical knowledge that
makes this a bad idea it's a lack of
perspective sometimes it's a good idea
to have a professional who is objective
and has proper training looking at one
situation to determine what's going on
kind of bypasses the lack of insight
component that we sometimes see with
mental disorders so the next point
really builds on this self diagnosis
statement so we see here that Tricia
diagnosed herself with both multiple
personality disorder and dissociative
identities order indicating that there
are some differences in the next video
she did she really doubled down on this
idea that these are two different
disorders I think this was really one of
the most controversial statements she
made because a lot of people have
opinions about this statement but to be
clear here they are technically two
different disorders one is no longer a
diagnosable disorder multiple
personality is gone again it was
abandoned when the DSM 4 was published
in 1994 the ID was the replacement for
multiple personality ID is a bit
different for example it expanded
amnesia to everyday events and not just
areas around trauma so it's a little bit
like hypochondriasis and somatic symptom
disorder yes they are two different
disorders technically but somebody
wouldn't be diagnosed with both because
the former is no longer diagnoseable
right so this kind of shows that maybe
she didn't understand that the ID was
the replacement for multiple personality
disorder
it didn't add to it both aren't out
there eligible for diagnosis the next
point tricia indicates that dissociating
comes in different forms than the alters
so the current conceptualization of the
alters is that they are dissociated
states so I'm not really sure what she's
talking about here it seems clear she's
trying to describe something it's just
impossible to know what that is
there wouldn't be alters without
dissociation it's literally in the name
dissociative I tell you disorder right
so it's a key part of the disorder now
the next point is just something I found
interesting it's really not particularly
important when she said she didn't want
to scare people I thought to myself too
late right that's just popped in my head
it's not the D ID that's scary it's the
lack of knowledge that we see expressed
here that's downright frightening next
point Trish indicates that the alters
are assisting the primary personnel
which she refers to as Trish I guess
because that's her name that makes sense
so it's almost like she's describing the
alters like they get together to have
meetings like they're on a committee or
something I don't know I've never seen
altars described that way altars aren't
enjoyable they're not usually
conceptualized as helpful like they come
in and get together and advise the
primary personality right so that's just
an unusual description of the ID altars
the next point Trish in a sense holds
the altars responsible for some of her
behavior now I'm not judging the
behavior
I'm simply noting what she's saying in a
situation
she says that the altars have caused
failed relationships she says one of the
altars can't stop eating this type of
characterization is really one of the
criticisms that researchers have of the
construct of di D allowing somebody to
place blame on an alternate personality
now this may be her experience I'm not
saying this isn't happening to her I'm
just pointing out how some may react to
this type of characterization Trish
indicates that she doesn't consider the
di D to be a problem or an issue she
says maybe it's just her imagination and
she's being creative well by definition
di D does cause clinically significant
distress I talked about that before in
her follow-up video to be fair she does
portray her experiences as much more
distressing right so I'm not sure why
that wasn't mentioned in the first video
but either way she does say that later
on my last thought here generally in
this video we just see kind of a stream
of consciousness it's impressionistic
like talking about something without any
detail just talking in a seemingly
random and disorganized way I don't
think this is very useful I guess it has
some entertainment value I'm not really
sure but it certainly doesn't have any
educational value one example of this we
see that Trish refers to her primary
personality as dissociating the most
without dissociating if that makes sense
that's what she says nothing about that
makes sense so to sum up my thoughts on
the video well on one hand one could
argue that this is a
of a young woman talking about her
personal experiences she does use some
of the technical terminology
inaccurately
but she wasn't representing this as a
scientific discussion in her video right
she didn't frame her video as
educational on the other hand I do feel
that content creators need to exercise
more caution when straying into areas
where they lack knowledge essentially I
think about this in two ways
signal-to-noise ratio and accuracy so
it's signaled a noise if you're talking
on a cell phone what somebody says their
words would be the signal and the static
would be the noise you want to hear the
signal you want to hear the message and
the more static there is the harder
becomes to hear that message this video
by Trisha has a lot of noise the other
element is the signal accuracy so if you
can hear the signal if you can get past
the noise is the signal actually giving
you useful information in this video
published by Trisha Paytas I don't see
where there's a lot of accuracy right so
we see two major problems in terms of
communicating information now there was
one positive thing that I think came
from this video and that is that it
really highlighted GID rights brought
this into a more popular discussion
right so I think that's one of the
positive elements I see a lot of times
when kind of popular YouTube content
creators venture into the area of mental
health I may not like the lack of
technical accuracy but I am happy it's
being brought into the wider discussion
so I know whenever I talk about topics
like D ID there will be a variety of
opinions please put any opinions and
thoughts in the comment section they
always generate an interesting dialogue
as always I hope you found my analysis
of this topic to be interesting thanks
for watching