The Scientific Status of Childhood Dissociative Identity Disorder: A Review of Published Research
[10] Several Turkish studies not included by Boysen imply the presence of child and adolescent DID as a relatively common phenomenon although this was not emphasized by the authors of these papers at the time of publication [11, 12] The question remains why epidemiological studies of DID in children in the community lag behind those for adults [13] Overcoming this gap would require utilization of diagnostic instruments rather than self rating measures [14] Even in the adult literature, many general psychiatric diagnostic assessment instruments lack a section on dissociative disorders. As a result, specific instruments have been developed, such as the Structured Clinical Interview for Dissociative Disorders [15] and the Dissociative Disorders Interview Schedule [16] Such instruments are needed for dissociative disorders in children as well. Their development, however, presents considerable challenges, including age related language differences. Consequently, a valid and reliable instrument for dissociative disorders in childhood, the Child Dissociative Checklist [17, 18] is administered to the child's caregiver, rather than the child himself/herself. We believe that future research should add an age sensitive clinical evaluation stage to screening studies on children and adolescents in the community. In his review on the scientific status of childhood dissociative identity disorder (DID) Boysen [1] brings into focus a relatively neglected area of child psychiatry. Indeed, studies on dissociative disorders in children have lagged well behind those conducted in adults. Nevertheless, we believe that some of the author's conclusions seem unwarranted. Moreover, his search missed many articles. For instance, the author claims that more research is needed before DID in childhood can be considered anything other than an extremely rare and poorly understood phenomenon that was briefly the object of intense scientific interest and speculation' (p. 333) While we welcome the author's invitation for more research on the subject, the conclusion in the latter part of the sentence cannot be drawn without appropriate and rigorous screening studies demonstrating its 'extreme rarity' We believe that the author's claim that 'the non Western cases of DID did not occur in isolation from Western influence' because 'these international researchers published their work in Englishlanguage journals and cited Western literature on DID' (p. 332) reflects not only a culture centric double bind [2] but is also disrespectful by suggesting a lack of autonomous thought from nonNorth American clinicians and researchers. Given English is the primary language of scientific communication, non Western researchers are likely to be drawn to publish their work in Englishlanguage journals so others working in similar areas have access to their ideas. Nevertheless, the author has not cited several articles on child and adolescent DID published in Turkish [3 9] His searches appear to be limited to English. The author is correct in his statement that the diagnosis was made in clinical settings for most of the published cases of child DID. However, there are many clues about the presence of undetected cases in the community. It is of enormous interest that in one Turkish screening study conducted on an emergency psychiatric ward, 2 of 4 of the patients below 18 years of age had DID Received: September 9, 2011 Accepted: September 19, 2011 Published online: March 17, 2012
Psychotherapy and Psychosomatics