Dissociative Identity Disorder (DID) in DSM-5

Dissociative Identity Disorder (DID)

• DID is a psychiatric syndrome characterized by the existence of 2 or more distinct personalities within an individual.
• Formerly known as Multiple Personality Disorder (MPD).
• Characterized by:
  • The presence of 2 or more distinct personality states or experience of possession.
  • Recurrent episodes of amnesia.
  • Amnesia or gaps in recall may occur in everyday events.
  • Symptoms of DID may be reported by the individual or observed by others.
  • Change or transition from one personality state to another is often very sudden, triggered by stress or environmental stimuli.

Dissociative Amnesia

• Refers to complete or partial memory loss of an event, series of events, or some segments of one's life experiences due to physical trauma, neurophysiological disturbances, or psychological factors.
• One of the criteria for DID.
• Classified into:
  • Retrograde amnesia: Loss of memory for past events.
  • Anterograde amnesia: Inability to form new memories after an event.
  • Localised amnesia: Failure to recall events during a circumscribed period of time.
  • Generalised amnesia: Rare and more severe form of amnesia.

Dissociation

• Exists on a continuum from normal to pathological.
• Normal: Daydreaming.
• Pathological: Extreme amnesia of past events or dissociative identity disorder.
• DSM-5 identifies 5 different dissociative disorders.
• Characterized by "A disruption of and/or discontinuity in the normal integration of consciousness, memory, identity, perception, body representations, motor control, and behaviour."

Competency to Stand Trial

• Defendants are competent to stand trial if they have:
  • Sufficient present ability to consult with their lawyer with a reasonable degree of rational understanding.
  • Rational or factual understanding of proceedings.
• Law states:
  • Person who is incompetent must not be tried.
  • Competency is required at every stage of criminal justice proceedings.
• Incompetence also refers to:
  • Lack of understanding of court proceedings, one's rights, or function performed by one's lawyer.
  • May not know they do not have to take the stand or not understand the terms used in court.

Adjunctive Competence

• The ability to participate in a variety of court proceedings.
• Relates to the ability to participate in a wide variety of court proceedings or court-related activities.
• Encompasses 2 distinct concepts:
  • Competence to proceed.
  • Implied understanding of the purpose of the proceedings.
  • Being able to help one's attorney.
  • Decisional competence.
  • Implies ability to comprehend the significance of various decisions to be made.

Incompetent to Stand Trial (IST)

• A judicial ruling that a criminal defendant, due to mental illness, defect, or other reasons, is unable to understand the nature and objective of the criminal proceedings or is unable to assist their defence lawyer.
• May apply to various judicial stages, including plea bargaining, trial, and sentencing.

Risk Assessment

• Actuarial approach:
  • Measured developed on specific populations – not generalise to others.
  • Restrictive definition of violence, risk, cannot address duration, severity, or frequency.
  • Unable to apply professional judgement – like weighing importance of risk factors.
• Structured Professional Judgement (SPJ) approach:
  • Combines the strength of actuarial predictions with the experience of practitioners.
  • Offers guidelines for providing the risk assessment.
  • Recommends that clinicians abide by established guidelines for conducting a careful assessment of whether an individual is likely to be violent.
  • Critical background is gathered – includes presence of risk and protective factors for the person being assessed.
  • Clinician weighs importance of factors and considers the extent to which the person may be violent and under which circumstances.