Editing Dissociative identity disorder (section)

==Epidemiology==
===General===
According to the American Psychiatric Association, the 12-month prevalence of DID among adults in the US is 1.5%, with similar prevalence between women and men.<ref name="Reategui-2019">{{Cite journal |last=Reategui |first=Albana |date=2019 |title=Dissociative Identity Disorder: A Literature Review |journal=Brigham Young University Undergraduate Journal of Psychology}}</ref> Population prevalence estimates have been described to widely vary, with some estimates of DID in inpatient settings suggesting 1-9.6%."<ref name = Hersen2012/> Reported rates in the community vary from 1% to 3% with higher rates among psychiatric patients.<ref name = Guidelines2011/><ref name = Cardena/> As of 2017, evidence suggested a prevalence of DID of 2–5% among psychiatric inpatients, 2–3% among outpatients, and 1% in the general population.<ref name="Vedat"/>

As of 2012, DID was diagnosed 5 to 9 times more common in women than men during young adulthood, although this may have been due to selection bias as men meeting DID diagnostic criteria were suspected to end up in the criminal justice system rather than hospitals.<ref name = Hersen2012/> DID diagnoses are extremely rare in children; much of the research on childhood DID occurred in the 1980s and 1990s and does not address ongoing controversies surrounding the diagnosis.<ref name="Boysen">{{cite journal | author = Boysen, G.A. | year = 2011 | title = The scientific status of childhood dissociative identity disorder: a review of published research | journal = Psychotherapy and Psychosomatics | volume = 80 | issue = 6 | pages = 329–34 | pmid = 21829044 | doi = 10.1159/000323403 | s2cid = 6083787 }}</ref> DID occurs more commonly in young adults<ref name="Sadockconcise">{{cite book |last=Kaplan |first=B.J. |year=2008 |title=Kaplan & Sadock's Concise Textbook of Clinical Psychiatry |author2=Sadock, V.A. |publisher=[[Lippincott Williams & Wilkins]] |isbn=978-0-7817-8746-8 |edition=3rd |location=Philadelphia, PA |pages=299–300 |chapter=Dissociative disorders – Dissociative identity disorder |chapter-url=https://books.google.com/books?id=ubG51n2NgfwC&pg=PA299}}</ref> and declines in prevalence with age.<ref>{{cite book | last = Thornhill | first = J.T. | date = 2011-05-10 |df=dmy-all | title = Psychiatry | edition = 6 | publisher = Wolters Kluwer Health/Lippincott Williams & Wilkins | location = Philadelphia | isbn = 978-1-60831-574-1 | page = 169 | url = https://books.google.com/books?id=KAoxvjwP57QC&pg=PA169}}</ref>

There is a poor awareness of DID in the clinical settings and the general public. Poor clinical education (or lack thereof) for DID and other dissociative disorders has been described in literature: "most clinicians have been taught (or assume) that DID is a rare disorder with a florid, dramatic presentation."<ref name="Guidelines2011" /><ref name="Stern" /> Symptoms in patients are often not easily visible, which complicates diagnosis.<ref name="Guidelines2011" /> DID has a high correlation with, and has been described as a form of, [[complex post-traumatic stress disorder]].<ref>{{Cite journal |last=Ducharme |first=Elaine L. |date=September 2017 |title=Best practices in working with complex trauma and dissociative identity disorder |journal=Practice Innovations |volume=2 |issue=3 |pages=150–161 |doi=10.1037/pri0000050 |s2cid=149049584 }}</ref> There is a significant overlap of symptoms between [[borderline personality disorder]] and DID.<ref>{{cite journal |last1=Al-Shamali |first1=Huda F |last2=Winkler |first2=Olga |last3=Talarico |first3=Fernanda |last4=Greenshaw |first4=Andrew J |last5=Forner |first5=Christine |last6=Zhang |first6=Yanbo |last7=Vermetten |first7=Eric |last8=Burback |first8=Lisa |title=A systematic scoping review of dissociation in borderline personality disorder and implications for research and clinical practice: Exploring the fog |journal=Australian & New Zealand Journal of Psychiatry |date=October 2022 |volume=56 |issue=10 |pages=1252–1264 |doi=10.1177/00048674221077029 |pmid=35152771 |pmc=9511244 }}</ref>

===Historical prevalence===
Rates of diagnosed DID were increasing in the late 20th century, reaching a peak of diagnoses at approximately 40,000 cases by the end of the 20th century, up from less than 200 diagnoses before 1970.<ref name = APA2008/><ref name = Hersen2012/> Initially DID along with the rest of the [[dissociative disorders]] were considered the rarest of psychological conditions, diagnosed in less than 100 by 1944, with only one further case reported in the next two decades.<ref name =Kihlstrom/> In the late 1970s and '80s, the number of diagnoses rose sharply.<ref name =Kihlstrom/> An estimate from the 1980s placed the incidence at 0.01%.<ref name = APA2008/> Accompanying this rise was an increase in the number of alters, rising from only the primary and one alter personality in most cases, to an average of 13 in the mid-1980s (the increase in both number of cases and number of alters within each case are both factors in professional skepticism regarding the diagnosis).<ref name = Kihlstrom/> Others explain the increase as being due to the use of inappropriate therapeutic techniques in highly suggestible individuals, though this is itself controversial<ref name = Blackwell/><ref name = Weiten/> while proponents of DID claim the increase in incidence is due to increased recognition of and ability to recognize the disorder.<ref name = Hersen2012/>

A 1996 essay suggested three possible causes for the sudden increase of DID diagnoses, among which the author suspects the first being most likely:<ref name="Paris J 1996">{{cite journal |author=Paris J |year=1996 |title=Review-Essay: Dissociative Symptoms, Dissociative Disorders, and Cultural Psychiatry |journal=Transcult Psychiatry |volume=33 |issue=1 |pages=55–68 |doi=10.1177/136346159603300104 |s2cid=145705618}}</ref>

# The result of therapist suggestions to suggestible people, much as [[Jean-Martin Charcot|Charcot]]'s hysterics acted in accordance with his expectations.
# Psychiatrists' past failure to recognize dissociation being redressed by new training and knowledge.
# Dissociative phenomena are actually increasing, but this increase only represents a new form of an old and protean entity: "hysteria".
Dissociative disorders were excluded from the [[Psychiatric epidemiology#Example: The Epidemiological Catchment Area Project|Epidemiological Catchment Area Project]].<ref>{{Cite book |last=A |first=Eaton, W W Regier, D A Locke, B Z Taube, C |title=The Epidemiologic Catchment Area Program of the National Institute of Mental Health. |oclc=679135747}}</ref>

===North America===
DID continues to be considered a controversial diagnosis; it was once regarded as a phenomenon confined to North America, though studies have since been published from DID populations across 6 continents.<ref name="pmid15503730">{{cite journal |vauthors=Piper A, Merskey H |year=2004 |title=The persistence of folly: A critical examination of dissociative identity disorder. Part I. The excesses of an improbable concept |url=https://journals.sagepub.com/doi/epdf/10.1177/070674370404900904 |journal=Canadian Journal of Psychiatry |volume=49 |issue=9 |pages=592–600 |doi=10.1177/070674370404900904 |pmid=15503730 |s2cid=16714465 |doi-access=free}}</ref><ref name="pmid7794202" /> Although research has appeared discussing the appearance of DID in other countries and cultures<ref>{{cite book |editor = Rhoades GF |editor2=Sar V | year = 2006 | title = Trauma And Dissociation in a Cross-cultural Perspective: Not Just a North American Phenomenon | publisher = [[Routledge]] | isbn = 978-0-7890-3407-6 | url = https://books.google.com/books?id=P_1-ytM7ty8C}}</ref> and the condition has been described in non-English speaking nations and non-Western cultures, these reports all occur in English-language journals authored by international researchers who cite Western scientific literature.<ref name="Boysen" />

===Social media===

A paper published in 2022 in the journal [[Comprehensive Psychiatry]] described how prolonged social media use, especially on video-sharing platforms including [[TikTok]], has exposed young people, largely adolescent females, a core user group of TikTok, to a growing number of content creators making videos about their self-diagnosed disorders. "An increasing number of reports from the US, UK, Germany, Canada, and Australia have noted an increase in functional tic-like behaviors prior to and during the [[COVID-19 pandemic]], coinciding with an increase in social media content related to[...]dissociative identity disorder." Authors noted that such cases of self-diagnosed DID (amongst other conditions) often differ from clinically defined symptoms of the disorder, creating the possibility of malingering, and potential negative impacts on those with clinically diagnosed DID seeking integrative therapy. The paper concluded that there "is an urgent need for focused empirical research investigation into this concerning phenomenon that is related to the broader research and discourse examining social media influences on mental health".<ref>{{Cite news |last=Davey |first=Melissa |date=2023-01-08 |title='Urgent need' to understand link between teens self-diagnosing disorders and social media use, experts say |language=en-GB |work=The Guardian |url=https://www.theguardian.com/australia-news/2023/jan/09/urgent-need-to-understand-link-between-teens-self-diagnosing-disorders-and-social-media-use-experts-say }}</ref><ref>{{Cite journal |last1=Haltigan |first1=John D. |last2=Pringsheim |first2=Tamara M. |last3=Rajkumar |first3=Gayathiri |date=2023-02-01 |title=Social media as an incubator of personality and behavioral psychopathology: Symptom and disorder authenticity or psychosomatic social contagion? |journal=Comprehensive Psychiatry |volume=121 |pages=152362 |doi=10.1016/j.comppsych.2022.152362 |pmid=36571927 |s2cid=254628655 |doi-access=free }}</ref><ref>{{Cite journal |last=Giedinghagen |first=Andrea |date=January 2023 |title=The tic in TikTok and (where) all systems go: Mass social media induced illness and Munchausen's by internet as explanatory models for social media associated abnormal illness behavior |url=http://journals.sagepub.com/doi/10.1177/13591045221098522 |journal=Clinical Child Psychology and Psychiatry |language=en |volume=28 |issue=1 |pages=270–278 |doi=10.1177/13591045221098522 |pmid=35473358 |s2cid=248403566 |issn=1359-1045}}</ref><ref name="pmid37271332">{{cite journal| author=Porter CA, Mayanil T, Gupta T, Horton LE| title=#DID: The Role of Social Media in the Presentation of Dissociative Symptoms in Adolescents. | journal=J Am Acad Child Adolesc Psychiatry | year= 2023 | volume=  63| issue=  2| pages=  S0890–8567(23)00302–7| pmid=37271332 | doi=10.1016/j.jaac.2023.03.021 | pmc= | s2cid=259057306 | url=https://pubmed.ncbi.nlm.nih.gov/37271332  }}</ref>