Editing Dissociative identity disorder (section)

==History==
[[File:Vivé.jpg|thumb|left|One of ten photogravure portraits of [[Louis Vivet]] published in ''Variations de la personnalité'' by [[Henri Bourru]] and [[Prosper Ferdinand Burot]]]]

===Early references===
In the 19th century, ''dédoublement,'' or "double consciousness", the historical precursor to DID, was frequently described as a state of [[sleepwalking]], with scholars hypothesizing that the patients were switching between a normal consciousness and a "somnambulistic state".<ref name = Kloet2012>{{cite journal | last1 = Van Der Kloet | first1 = D. | last2 = Merckelbach | first2 = H. | last3 = Giesbrecht | first3 = T. | last4 = Lynn | first4 = S. J. | title = Fragmented Sleep, Fragmented Mind: The Role of Sleep in Dissociative Symptoms | journal = Perspectives on Psychological Science | volume = 7 | issue = 2 | pages = 159–175 | year = 2012 | pmid =  26168441| doi = 10.1177/1745691612437597 | s2cid = 8919592 }}</ref>

An intense interest in [[Spiritualism (beliefs)|spiritualism]], [[parapsychology]] and [[hypnosis]] continued throughout the 19th and early 20th centuries,<ref name="pmid7794202">{{cite journal |vauthors=Atchison M, McFarlane AC | title = A review of dissociation and dissociative disorders | journal = The Australian and New Zealand Journal of Psychiatry | volume = 28 | issue = 4 | pages = 591–9 | year = 1994 | pmid = 7794202 | doi = 10.3109/00048679409080782 }}</ref> running in parallel with [[John Locke]]'s views that there was an [[association of ideas]] requiring the coexistence of feelings with awareness of the feelings.<ref name="pmid12094818">{{cite journal | author = Rieber RW | title = The duality of the brain and the multiplicity of minds: can you have it both ways? | journal = History of Psychiatry | volume = 13 | issue = 49 Pt 1 | pages = 3–17 | year = 2002 | pmid = 12094818 | doi = 10.1177/0957154X0201304901 | s2cid = 22746038 }}</ref> [[Hypnosis]], which was pioneered in the late 18th century by [[Franz Mesmer]] and [[Armand-Marie-Jacques de Chastenet, Marques of Puységur|Armand-Marie Jacques de Chastenet, Marques de Puységur]], challenged Locke's association of ideas. Hypnotists reported what they thought were second personalities emerging during hypnosis and wondered how two minds could coexist.<ref name="pmid7794202" />

[[File:Plaque Pierre Janet, 54 rue de Varenne, Paris 7.jpg|thumb|The plaque on the former house of [[Pierre Janet|Pierre Marie Félix Janet]] (1859–1947), the philosopher and psychologist who first alleged a connection between events in the subject's past and present mental health, also coining the words "dissociation" and "subconscious"]]

In the 19th century, there were a number of reported cases of multiple personalities which Rieber<ref name="pmid12094818"/> estimated would be close to 100. [[Epilepsy]] was seen as a factor in some cases,<ref name="pmid12094818" /> and discussion of this connection continues into the present era.<ref name="pmid6427406">{{cite journal |vauthors=Cocores JA, Bender AL, McBride E | title = Multiple personality, seizure disorder, and the electroencephalogram | journal = The Journal of Nervous and Mental Disease | volume = 172 | issue = 7 | pages = 436–438 | year = 1984 | pmid = 6427406 | doi = 10.1097/00005053-198407000-00011 }}</ref><ref name="pmid2725878">{{cite journal |vauthors=Devinsky O, Putnam F, Grafman J, Bromfield E, Theodore WH | title = Dissociative states and epilepsy | journal = Neurology | volume = 39 | issue = 6 | pages = 835–840 | year = 1989 | pmid = 2725878 | doi = 10.1212/wnl.39.6.835 | s2cid = 31641885 }}</ref>

By the late 19th century, there was a general acceptance that emotionally traumatic experiences could cause long-term disorders which might display a variety of symptoms.<ref name="Borch-Jacobsen M 2000">{{cite journal | author = Borch-Jacobsen M | title = How to predict the past: from trauma to repression | journal = History of Psychiatry | volume = 11 | issue = 41 Pt 1 | pages = 15–35 | year = 2000 | pmid = 11624606 | doi = 10.1177/0957154X0001104102 | s2cid = 32666101 }}</ref> These [[conversion disorder]]s were found to occur in even the most resilient individuals, but with profound effect in someone with emotional instability like [[Louis Vivet]] (1863–?), who had a traumatic experience as a 17-year-old when he encountered a viper. Vivet was the subject of countless medical papers and became the most studied case of dissociation in the 19th century.

Between 1880 and 1920, various international medical conferences devoted time to sessions on dissociation.<ref name="putnam">{{cite book | last = Putnam | first = Frank W. | title = Diagnosis and Treatment of Multiple Personality Disorder | url = https://archive.org/details/diagnosistreatme00putnrich | url-access = registration | publisher = The Guilford Press | year = 1989 | location =New York | page = [https://archive.org/details/diagnosistreatme00putnrich/page/351 351] | isbn = 978-0-89862-177-8}}</ref> It was in this climate that [[Jean-Martin Charcot]] introduced his ideas of the impact of nervous shocks as a cause for a variety of neurological conditions. One of Charcot's students, [[Pierre Janet]], took these ideas and went on to develop his own theories of dissociation.<ref name="pmid2686473">{{cite journal |vauthors=van der Kolk BA, van der Hart O | title = Pierre Janet and the breakdown of adaptation in psychological trauma | journal = Am J Psychiatry | volume = 146 | issue = 12 | pages = 1530–40 | date = December 1989 | pmid = 2686473 | doi =  10.1176/ajp.146.12.1530| citeseerx = 10.1.1.455.2523 }}</ref> One of the first individuals diagnosed with multiple personalities to be scientifically studied was Clara Norton Fowler, under the [[pseudonym]] [[Christine Beauchamp (pseudonym)|Christine Beauchamp]]; American [[neurology|neurologist]] [[Morton Prince]] studied Fowler between 1898 and 1904, describing her [[case study]] in his 1906 [[monograph]], ''Dissociation of a Personality''.<ref name="pmid2686473"/><ref>{{cite book|url=https://archive.org/details/dissociationofpe00prinuoft|page=[https://archive.org/details/dissociationofpe00prinuoft/page/1 1]|quote=Louis Vivé.|title=The Dissociation of a Personality|publisher=Longmans, Green|last1=Prince|first1=Morton|year=1920}}</ref>

===20th century===
In the early 20th century, interest in dissociation and multiple personalities waned for several reasons. After Charcot's death in 1893, many of his so-called hysterical patients were exposed as frauds, and Janet's association with Charcot tarnished his theories of dissociation.<ref name="pmid7794202" /> [[Sigmund Freud]] recanted his earlier emphasis on dissociation and childhood trauma.<ref name="pmid7794202" />

In 1908, [[Eugen Bleuler]] introduced the term ''"schizophrenia"'' to represent a revised disease concept for Emil Kraepelin's ''[[dementia praecox]].''<ref name="Noll 2011">{{cite book|last=Noll | first = R | title = American Madness: The Rise and Fall of Dementia Praecox | year = 2011 | publisher= [[Harvard University Press]]|location=Cambridge, Massachusetts}}</ref> Whereas Kraepelin's natural disease entity was anchored in the metaphor of progressive deterioration and mental weakness and defect, Bleuler offered a reinterpretation based on dissociation or "splitting" (''Spaltung'') and widely broadened the inclusion criteria for the diagnosis. A review of the ''[[Index medicus]]'' from 1903 through 1978 showed a dramatic decline in the number of reports of multiple personality after the diagnosis of schizophrenia became popular, especially in the United States.<ref name="pmid7004385">{{cite journal | author = Rosenbaum M | title = The role of the term schizophrenia in the decline of diagnoses of multiple personality | journal = Arch. Gen. Psychiatry | volume = 37 | issue = 12 | pages = 1383–5 | year = 1980 | pmid = 7004385 | doi = 10.1001/archpsyc.1980.01780250069008 }}</ref> The rise of the broad diagnostic category of dementia praecox has also been posited in the disappearance of "hysteria" (the usual diagnostic designation for cases of multiple personalities) by 1910.<ref>{{cite journal | author = Micale MS | title = On the disappearance of hysteria: A study in the clinical deconstruction of a diagnosis | journal = Isis | volume = 84 | issue = 3 | pages = 496–526 | year = 1993 | pmid = 8282518 | doi = 10.1086/356549 | s2cid = 37252994 }}</ref> A number of factors helped create a large climate of skepticism and disbelief; paralleling the increased suspicion of DID was the decline of interest in dissociation as a laboratory and clinical phenomenon.<ref name="putnam"/>

Starting in about 1927, there was a large increase in the number of reported cases of schizophrenia, which was matched by an equally large decrease in the number of multiple personality reports.<ref name="putnam"/> With the rise of a uniquely American reframing of dementia praecox/schizophrenia as a functional disorder or "reaction" to psychobiological stressors – a theory first put forth by [[Adolf Meyer (psychiatrist)|Adolf Meyer]] in 1906—many trauma-induced conditions associated with dissociation, including "shell shock" or "war neuroses" during World War I, were subsumed under these diagnoses.<ref name="Noll 2011"/> It was argued in the 1980s that DID patients were often misdiagnosed with schizophrenia.<ref name=putnam/>

The public, however, was exposed to psychological ideas which took their interest. [[Mary Shelley]]'s ''[[Frankenstein]]'', [[Robert Louis Stevenson]]'s ''[[Strange Case of Dr Jekyll and Mr Hyde]]'', and many short stories by [[Edgar Allan Poe]] had a formidable impact.<ref name=pmid12094818/>

====''The Three Faces of Eve''====
In 1957, with the publication of the bestselling book ''The Three Faces of Eve'' by psychiatrists [[Corbett H. Thigpen]] and [[Hervey M. Cleckley]], based on a [[case study]] of their patient [[Chris Costner Sizemore]], and the subsequent popular [[The Three Faces of Eve|movie of the same name]], the American public's interest in multiple personality was revived. More cases of dissociative identity disorder were diagnosed in the following years.<ref name="Schacter, D. L. 2011">{{cite book |author1=Schacter, D.L. |author2=Gilbert, D.T. |author3=Wegner, D.M. |year=2011 |title=Psychology |edition=2nd |page=572 |place=New York, NY |publisher=Worth}}</ref> The cause of the sudden increase of cases is indefinite, but it may be attributed to the increased awareness, which revealed previously undiagnosed cases or new cases may have been induced by the influence of the media on the behavior of individuals and the judgement of therapists.<ref name="Schacter, D. L. 2011"/> During the 1970s an initially small number of clinicians campaigned to have it considered a legitimate diagnosis.<ref name="putnam"/>

===History in the DSM===
The DSM-II used the term ''hysterical neurosis, dissociative type''. It described the possible occurrence of alterations in the patient's state of consciousness or identity, and included the symptoms of "amnesia, somnambulism, fugue, and multiple personality".<ref name=dsmii/> The DSM-III grouped the diagnosis with the other four major [[dissociative disorders]] using the term "multiple personality disorder". The [[Diagnostic and Statistical Manual of Mental Disorders|DSM-IV]] made more changes to DID than any other dissociative disorder,<ref name = Cardena/> and renamed it DID.<ref name=dsm/> The name was changed for two reasons: First, the change emphasizes the main problem is not a multitude of personalities, but rather a lack of a single, unified identity<ref name = Cardena/> and an emphasis on "the identities as centers of information processing".<ref name = Spiegel/> Second, the term "personality" is used to refer to "characteristic patterns of thoughts, feelings, moods, and behaviors of the whole individual", while for a patient with DID, the switches between identities and behavior patterns is the personality.<ref name = Cardena/> It is, for this reason, the DSM-IV-TR referred to "distinct identities or personality states" instead of personalities. The diagnostic criteria also changed to indicate that while the patient may name and personalize alters, they lack independent, objective existence.<ref name = Cardena/> The changes also included the addition of amnesia as a symptom, which was not included in the DSM-III-R because despite being a core symptom of the condition, patients may experience "amnesia for the amnesia" and fail to report it.<ref name = Spiegel/> Amnesia was replaced when it became clear that the risk of [[Type II error|false negative]] diagnoses was low because amnesia was central to DID.<ref name = Cardena/>

The [[ICD-10]] places the diagnosis in the category of "dissociative disorders", within the subcategory of "other dissociative (conversion) disorders", but continues to list the condition as multiple personality disorder.<ref name="ICD10">{{cite web|title=The ICD-10 Classification of Mental and Behavioural Disorders|url=https://www.who.int/classifications/icd/en/GRNBOOK.pdf |archive-url=https://ghostarchive.org/archive/20221009/https://www.who.int/classifications/icd/en/GRNBOOK.pdf |archive-date=2022-10-09 |url-status=live|publisher=[[World Health Organization]]}}</ref>

The DSM-IV-TR criteria for DID have been criticized for failing to capture the clinical complexity of DID, lacking usefulness in diagnosing individuals with DID (for instance, by focusing on the two least frequent and most subtle symptoms of DID) producing a high rate of [[Type II error|false negatives]] and an excessive number of DDNOS diagnoses, for excluding [[Spirit possession|possession]] (seen as a cross-cultural form of DID), and for including only two "core" symptoms of DID (amnesia and self-alteration) while failing to discuss hallucinations, trance-like states, [[somatoform disorder|somatoform]], [[depersonalization]], and [[derealization]] symptoms. Arguments have been made for allowing diagnosis through the presence of some, but not all of the characteristics of DID rather than the current exclusive focus on the two least common and noticeable features.<ref name = Spiegel/> The DSM-IV-TR criteria have also been criticized<ref>{{cite journal |last1=Warelow |first1=Philip |last2=Holmes |first2=Colin A. |title=Deconstructing the DSM-IV-TR: A critical perspective: DECONSTRUCTING DIAGNOSTIC CATEGORIES |journal=International Journal of Mental Health Nursing |date=December 2011 |volume=20 |issue=6 |pages=383–391 |doi=10.1111/j.1447-0349.2011.00749.x <!--|access-date=4 May 2023-->|pmid=21605302 }}</ref> for being [[tautology (logic)|tautological]], using imprecise and undefined language and for the use of instruments that give a false sense of validity and empirical certainty to the diagnosis.

The [[DSM-5]] updated the definition of DID in 2013, summarizing the changes as:<ref name=highlights>{{cite web | title = Highlights of Changes from DSM-IV-TR to DSM-5 | url=http://www.psychiatry.org/File%20Library/Practice/DSM/DSM-5/Changes-from-DSM-IV-TR--to-DSM-5.pdf | archive-url=https://web.archive.org/web/20130917201810/http://www.psychiatry.org/File%20Library/Practice/DSM/DSM-5/Changes-from-DSM-IV-TR--to-DSM-5.pdf | archive-date=2013-09-17 | date = 2013-05-17 | publisher = [[American Psychiatric Association]] |access-date=2013-09-06}}</ref>

{{blockquote|Several changes to the criteria for dissociative identity disorder have been made in DSM-5. First, Criterion A has been expanded to include certain possession-form phenomena and functional neurological symptoms to account for more diverse presentations of the disorder. Second, Criterion A now specifically states that transitions in identity may be observable by others or self-reported. Third, according to Criterion B, individuals with dissociative identity disorder may have recurrent gaps in recall for everyday events, not just for traumatic experiences. Other text modifications clarify the nature and course of identity disruptions.}}

Between 1968 and 1980, the term that was used for dissociative identity disorder was "Hysterical neurosis, dissociative type". The APA wrote in the second edition of the DSM: "In the dissociative type, alterations may occur in the patient's state of consciousness or in his identity, to produce such symptoms as amnesia, somnambulism, fugue, and multiple personality."<ref name=dsmii>{{cite book | publisher = American Psychiatric Association | year = 1968 | chapter = Hysterical Neurosis | title = Diagnostic and statistical manual of mental disorders second edition | page = 40 | location = Washington, D.C. }}</ref> The number of cases sharply increased in the late 1970s and throughout the 80s, and the first scholarly [[monograph]]s on the topic appeared in 1986.<ref name = Kihlstrom/>

====Book and film ''Sybil''====
In 1974, the highly influential book ''[[Sybil (Schreiber book)|Sybil]]'' was published, and later made into a [[miniseries]] in [[Sybil (1976 film)|1976]] and [[Sybil (2007 film)|again in 2007]]. Describing what Robert Rieber called "the third most famous of multiple personality cases,"<ref name = Rieber>{{cite journal | author = Rieber, R.W. | year = 1999 | title = Hypnosis, false memory and multiple personality: A trinity of affinity | journal = History of Psychiatry | volume = 10 | issue = 37 | pages = 3–11 | pmid = 11623821 | doi = 10.1177/0957154X9901003701 | s2cid = 41343058 }}</ref> it presented a detailed discussion of the problems of treatment of "Sybil Isabel Dorsett", a [[pseudonym]] for [[Shirley Ardell Mason]].

Though the book and subsequent films helped popularize the diagnosis and trigger an epidemic of the diagnosis,<ref name = Paris2012>{{cite journal | author = Paris, J. | year = 2012 | title = The rise and fall of dissociative identity disorder | journal = [[Journal of Nervous and Mental Disease]] | volume = 200 | issue = 12 | pages = 1076–1079 | pmid = 23197123 | doi = 10.1097/NMD.0b013e318275d285 | s2cid = 32336795 }}</ref> later analysis of the case suggested different interpretations, ranging from Mason's problems having been caused by the therapeutic methods and [[Sodium thiopental|sodium pentathol]] injections used by her psychiatrist, [[Cornelia B. Wilbur|C. B. Wilbur]], or an inadvertent hoax due in part to the lucrative publishing rights,<ref name = Rieber/><ref>{{cite book | last = Nathan | first = Debbie | author-link = Debbie Nathan | year = 2011 | title = Sybil exposed | publisher = [[Free Press (publisher)|Free Press]] | isbn = 978-1-4391-6827-1 | url = https://archive.org/details/sybilexposedextr00nath_0 }}</ref> though this conclusion has itself been challenged.<ref>{{cite journal | last = Lawrence | first = M. | year = 2008 | title = Review of ''Bifurcation of the Self: The History and Theory of Dissociation and its Disorders'' | journal = American Journal of Clinical Hypnosis | volume = 50 | issue = 3 | pages = 273–283 | doi=10.1080/00029157.2008.10401633| s2cid = 219594172 }}</ref>

David Spiegel, a Stanford psychiatrist whose father treated Shirley Ardell Mason on occasion, says that his father described Mason as "a brilliant hysteric. He felt that Wilbur tended to pressure her to exaggerate on the dissociation she already had."<ref>{{cite web |last1=Wilson |first1=Sianne |date=2014-11-24 |df=dmy-all |title=Sybil: A brilliant hysteric? |website=RetroReport.org |url=http://www.retroreport.org/video/sybil-a-brilliant-hysteric/ |access-date=14 August 2015}}</ref> {{Better source needed|date=June 2020|reason=I think Herbert Spiegel himself wrote about it.}} As media attention on DID increased, so too did the controversy surrounding the diagnosis.<ref name="Farrell">{{cite journal |author=Farrell, H.M. |year=2011 |title=Dissociative identity disorder: Medicolegal challenges |url=http://www.jaapl.org/content/39/3/402.full.pdf+html |journal=The Journal of the American Academy of Psychiatry and the Law |volume=39 |issue=3 |pages=402–406 |pmid=21908758}}</ref>

====Re-classifications====
The DSM-III intentionally omitted the terms "hysteria" and "neurosis", naming those as Dissociative Disorders, which included Multiple Personality Disorder,<ref>{{Cite book |last1=American Psychiatric Association |url=http://archive.org/details/diagnosticstatis00amer_1 |title=Diagnostic and statistical manual of mental disorders : DSM-III-R |last2=American Psychiatric Association. Work Group to Revise DSM-III |date=1987 |publisher=Washington, DC : American Psychiatric Association |others=Internet Archive |isbn=978-0-89042-018-8}}</ref> and also added Post-traumatic Stress Disorder in Anxiety Disorders section.

In the opinion of [[McGill University]] psychiatrist Joel Paris, this inadvertently legitimized them by forcing textbooks, which mimicked the structure of the DSM, to include a separate chapter on them and resulted in an increase in diagnosis of dissociative conditions. Once a rarely occurring spontaneous phenomenon (research in 1944 showed only 76 cases),<ref>{{cite news |title=''Creating Hysteria'' by Joan Acocella |year=1999 |newspaper=[[The New York Times]] |type=book review |url=https://www.nytimes.com/books/first/a/acocella-hysteria.html}}</ref> the diagnosis became "an artifact of bad (or naïve) psychotherapy" as patients capable of dissociating were accidentally encouraged to express their symptoms by "overly fascinated" therapists.<ref name=Paris2008>{{cite book |isbn=978-0-19-531383-3 |last=Paris |first=J |year=2008 |publisher=[[Oxford University Press]] |title=Prescriptions for the Mind: A Critical View of Contemporary Psychiatry |page=[https://books.google.com/books?id=g66_hwnQHU8C&pg=PA92 92]}}</ref>

"Interpersonality amnesia" was removed as a diagnostic feature from the DSM III in 1987, which may have contributed to the increasing frequency of the diagnosis.<ref name = Kihlstrom/> There were 200 reported cases of DID as of 1980, and 20,000 from 1980 to 1990.<ref name="pmid7788115">{{cite journal | author = Merskey H | title = Multiple personality disorder and false memory syndrome | journal = [[British Journal of Psychiatry]] | volume = 166 | issue = 3 | pages = 281–283 | year = 1995 | pmid = 7788115 | doi = 10.1192/bjp.166.3.281 | doi-access = free }}</ref> [[Joan Acocella]] reports that 40,000 cases were diagnosed from 1985 to 1995.<ref name="Accocella">{{cite book |last=Acocella |first=JR |author-link=Joan Acocella |title=Creating Hysteria: Women and Multiple Personality Disorder |publisher=Jossey-Bass |location=San Francisco |year=1999 |isbn=978-0-7879-4794-1 |url=https://archive.org/details/creatinghysteria00acoc }}</ref> Scientific publications regarding DID peaked in the mid-1990s, rapidly declined,<ref name = Pope/> then has continued on a steady increasing trend since.<ref name=boysen2024/>

In 1994, the fourth edition of the DSM replaced the criteria again and changed the name of the condition from "multiple personality disorder" to the current "dissociative identity disorder" to emphasize the importance of changes to consciousness and identity rather than personality. The inclusion of interpersonality amnesia helped to distinguish DID from [[dissociative disorder not otherwise specified]] (DDNOS), but the condition retains an inherent subjectivity due to difficulty in defining terms such as personality, identity, ego-state, and even [[amnesia]].<ref name = Kihlstrom>{{cite journal | author = Kihlstrom, J.F. | year = 2005 | title = Dissociative disorders | journal = Annual Review of Clinical Psychology | volume = 1 | pages = 227–53 | pmid = 17716088 | doi = 10.1146/annurev.clinpsy.1.102803.143925 | issue=1}}</ref> The [[ICD-10]] classified DID as a "Dissociative [conversion] disorder" and used the name "multiple personality disorder" with the classification number of F44.81.<ref name = ICD10/> In the [[ICD-11]], the [[World Health Organization]] have classified DID under the name "dissociative identity disorder" (code 6B64), and most cases formerly diagnosed as DDNOS are classified as "partial dissociative identity disorder" (code 6B65).<ref>{{cite web |title=ICD-11 for: 6B65 Partial dissociative identity disorder |series=Mortality and Morbidity Statistics |website=icd.who.int |url=https://icd.who.int/browse11/l-m/en#/http://id.who.int/icd/entity/988400777 |access-date=2022-05-25}}</ref>

===21st century===
A 2006 study compared scholarly research and publications on DID and [[dissociative amnesia]] to other mental health conditions, such as [[anorexia nervosa]], [[alcohol use disorder]], and [[schizophrenia]] from 1984 to 2003. The results were found to be unusually distributed, with a very low level of publications in the 1980s followed by a significant rise that peaked in the mid-1990s and subsequently rapidly declined in the decade following. Compared to 25 other diagnosis, the mid-1990s "bubble" of publications regarding DID was unique. In the opinion of the authors of the review, the publication results suggest a period of "fashion" that waned, and that the two diagnoses "presently do not command widespread scientific acceptance."<ref name = Pope>{{cite journal |vauthors=Pope HG, Barry S, Bodkin A, Hudson JI | title = Tracking scientific interest in the dissociative disorders: A study of scientific publication output 1984–2003 | journal = Psychotherapy and Psychosomatics | volume = 75 | issue = 1 | pages = 19–24 | year = 2006 | pmid = 16361871 | doi = 10.1159/000089223 | s2cid = 9351660 }}</ref> A 2024 review found "steady" continued research after 2011, with 160 academic studies located in the 2011-2021 period, an increase of 60% over the previous decade. Authors previously skeptical of DID have adopted a "trans-theoretical" approach where trauma and social factors are simply two of many potential factors, indicating that "the heat of past DID controversies has diminished some with the rise of multidimensional models of psychopathology".<ref name="boysen2024">{{cite journal |last=Boysen |first=Guy A. |year=2024 |title=Dissociative Identity Disorder: A Review of Research From 2011 to 2021 |journal=Nervous and Mental Disease |volume=212 |pages=174-186 |doi=10.1097/NMD.0000000000001764 |quote=Despite previous assertions about declining interest in DID (Pope et al., 2005), research output increased in the second decade of the 2000s.[...] It appears that the heat of past DID controversies has diminished some with the rise of multidimensional models of psychopathology, and research on the disorder, although limited in several ways, has steadily emerged the second decade of the century |number=3}}</ref>