No clinical observation of DID?

Well this is interesting. The whole purpose of dissociation is to keep secrets from the self and the world, secrets that would be dangerous to know and feel or act upon (in the case of severe chronic inescapable childhood trauma). These habits become firmly entrenched in childhood. Therefore clients don't typically come in and report they are dissociative because they don't know they are. And most clinicians don't ask the key questions, e.g., about internal voices, feeling as if they are watching themselves, feeling as if something is making themself doing so thing, in combination with lost time and bad headaches, among others in the symptom cluster.

And they don't have DID or DDNOS tattoed on their foreheads. They look like anybody else for the most part, though some have scars on their wrists or body from self mutilation. Therefore we can't rely on clinical observation. Instead, we have to rely upon measurement using instruments that have been validated, such as the SCID-D or the DDIS. Or at least the DES, a screening instrument.

Given the current state of knowledge regarding the incidence of dissociation in multiply traumatized people, I believe the current standard of care for EMDR practitioners or exposure therapists alike would be to assess dissociation using an appropriate instrument. What with the limitations of clinical observation I mean.

Replies:

Re:No clinical observation of DID?, by Cahill, 10/29/02

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