Israeli Mental Health Professionals' Attitudes Towards Dissociative Disorders, Reported Incidence and Alternative Diagnoses Considered

Abstract

ABSTRACT. Clinical diagnoses of dissociative disorders (DDs), including Dissociative Identity Disorder (DID), are controversial because there are mental health professionals in North America and elsewhere who are skeptical about whether these psychiatric disorders actually exist. This paper explores the attitudes of mental health professionals in Israel toward DDs and DID through a survey of 211 practicing clinicians (return rate of 39.5%). Of the sample, 95.5% scored at or above the point on a 5-point Likert scale measuring belief in the validity of DDs (m = 4.17, SD = 0.78); 84.5% declared at least a moderate belief in the validity of DID (M = 3.5, S.D. = 0.97). The average Israeli clinician surveyed had made 4.8 career-long DD diagnoses (S.D. = 18.06) and carried an average of 1.05 DD patients in his/her caseload (S.D. = 2.86). DID had a career-long diagnosis frequency of 0.14 patients per clinician (S.D. = 0.59) and was currently seen at a frequency of 0.03 cases per clinician (S.D. = 0.20). The five most frequently considered alternative diagnoses to DID in Israel were Borderline Personality Disorder (24%), Psychotic Disorder/Schizophrenia (23%), PTSD/Anxiety Disorder (10%), Malingering (8%) and Depressive Disorder (7%). The findings suggest that attitudes of Israeli clinicians are similar to those of North American clinicians despite the geographical and cultural differences between them.

The Persistence of Folly: A Critical Examination of Dissociative Identity Disorder. Part I. The Excesses of an Improbable Concept

“…Further, these North American countries export the concepts. In India, for example, the cinema has influenced the production of dissociative signs (10), and 4 recent papers demonstrate a recurring interest in spreading awareness of DID to other countries (11)(12)(13)(14).…”

Clandestine Psychopathology: Unrecognized Dissociative Disorders in Inpatient Psychiatry

“…First, the inability of many DD patients to express their internal experiences can be explained by their habitual silence acquired during years of hiding their secret of abuse, and by their motivation to present a healthier appearance to conceal their chaotic internal life (Spiegel, 2006). Another explanation for the underdiagnosis of many of our respondents might be found in clinicians' skepticism, lack of awareness, or poor diagnostic skills (e.g., Somer, 2000). Misperceptions regarding the rarity of these disorders (Leonard et al, 2005) and clinicians' reluctance to recognize and interact with the horrific results of abuse and the demanding complexity of these disorders (i.e., Perlman, 1995) may lower clinicians' motivation to acquire the necessary knowledge and skills.…”

“…A large scale survey among mental health professionals in Israel found that 63% of those interviewed had no experience either diagnosing or treating DD patients (Somer, 2000). These findings, ostensibly in line with arguments that both the diagnosis and its manifestations are socially construed North American phenomena (see Spanos, 1994), call for the need to investigate the validity of DD in Israel.…”

Advances in Dissociation Research and Practice in Israel

“…Further evidence of the budding awareness and interest in dissociative psychopathology in Israel was provided in a survey of the attitudes of 211 practicing clinicians in Israel toward dissociative disorders (DD) and DID (Somer, 2000a). Of the sample, 95.5% percent scored at or above the midpoint on a 5-point Likert scale measuring belief in the validity of DDs; 84.5% declared at least a moderate belief in the validity of DID.…”