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Why distance ourselves from dissociative disorders?

We've done the legwork necessary to build a solid case for doing so but what was the point? That's a good question. The problem with treating DP and DPD just like any other dissociative condition is that dissociative disorders research has its own axioms that are largely unhelpful in DP and DPD. As I've argued all along, depersonalization disorder is not like other dissociative disorders (if you even want to include it as a dissociative disorder at this point).

One of the widely-held beliefs about dissociation in the dissociative disorders research community (not depersonalization disorder researchers) is that (almost) all cases of dissociative disorders are the result of trauma (reflected in the fact that the biggest academic journal for dissociative disorders is called the Journal of Trauma & Dissociation). Studies of DPD sufferers have repeatedly failed to provide evidence for such a drastic claim. There's a good reason that specialist depersonalization researchers never publish in the Journal of Trauma & Dissociation.

It's an open secret that depersonalization researchers and dissociative disorders researchers don't think very much of each other. Despite the DSM-V classifying DPD as a dissociative disorder, the two sets of researchers may as well inhabit different worlds. They very rarely collaborate and their research frequently contradicts each other's. I consider the fact that depersonalization and depersonalization disorder lacks its own journal to be an advantage as it forces depersonalization researchers to publish in a wide variety of more mainstream psychiatric journals. By contrast, dissociative disorders research has become something of an echo chamber.

When sites dedicated to dissociative disorders cover depersonalization disorder (which, thanks to the DSM, they have a license to do), they're a hotbed of misinformation informed by their own bias towards compartmentalization-based dissociative disorders. The example given states that “many people with this disorder have a history of childhood trauma” and then goes on to recommend the SCID-D and DES as diagnostic tests with no mention of the CDS. For the grand finale, they completely mess up the section describing drug treatments (yet miraculously nail the details of the one psychotherapeutic trial). This is the dissociative disorders perspective in an nutshell: everything is trauma, dissociative disorders tests are always needed and the correct treatment is always psychotherapy. This is one of my major arguments against even having DPD in the same DSM category as the real dissociative disorders: people assume a homogeneity that simply doesn't exist.

Now to the task of demonstrating that trauma is not the major cause of depersonalization. In one of the largest epidemiological studies of depersonalization disorder to date, over 200 people with a diagnosis of DPD were compared to over 600 depressed controls without any kind of dissociative comorbidity. The results were really quite stunning: the DPD sample had a lower mean score on a measure of childhood abuse and trauma (CDT-20?) than the control group. This absolutely flies in the face of dissociative disorders research where, even on measures of self-reported abuse administered prior to treatment, the dissociative disorders group are always vastly overrepresented. The closest thing to a link between trauma and depersonalization was found in a much smaller study that found only a modest connection between emotional abuse and the development of DPD. In sum, the depersonalization research does not remotely favor a trauma-based explanation.

Where would you rather look?

The simple fact is that generalized dissociative disorders researchers don't have much to offer to the overwhelming majority of depersonalization sufferers. According to their view of dissociation as a spectrum, depersonalization disorder is the least severe dissociative disorder (which, in itself, is odd because there are people with utterly disabling DPD who never seem to “move up” on the spectrum). Very little of their research focuses on depersonalization disorder and when it does, it's still poisoned by their starting beliefs about the origin of dissociation (in particular, trauma, which has never been shown to apply to more than a small percentage of depersonalization sufferers). When they examine depersonalization as a phenomenon, it's typically in the context of a real dissociative disorder and viewed through the same lens.

If that wasn't enough for you, maybe consider the fact that dissociative disorders researchers (of the Trauma & Dissociation variety) have an order of magnitude more funding for their research than depersonalization researchers yet have never produced a single randomized-controlled trial of any of their methodologies in the treatment of depersonalization disorder. Actually, as far as I'm aware, they've never produced a single trial of any psychotherapeutic modality for depersonalization disorder at all. The International Society for the Study of Trauma and Dissociation (the organization responsible for the Journal of Trauma & Dissociation) admits quite freely how useless the dissociative disorders community has previously been at performing clinical trials.

Individual clinicians claim huge success rates at treating the various dissociative disorders but can never produce any evidence for their claims. Dr Steinberg is as guilty of this as anyone and she's already set the bar for “success” pretty low by pronouncing that if she could get her DID patients “co-operating” with their alters, she would count that a positive outcome for statistical purposes. Depersonalization researchers, on the contrary, have published numerous psychiatric and psychotherapeutic trials with varying degrees of success. The variation in their success rate not only seems more realistic but it shows a degree of concern about getting it right according to the established tenets of medicine and, more broadly, science.