Identifying Dissociative Disorders in Subclinical Populations: Treating DID Elizabeth Schenk, PhD, LCSW

May 10, 2013 6:45 AM | Admin EBCAMFT

Dissociative Identity Disorder (DID), long considered a rare condition, in actuality has a prevalence rate of 1-3% of the general population.  The vast majority of DID patients do not make their dissociative disorder obvious to others, nor is it obvious to themselves. There are windows of diagnosibility (Kluft, 1991, Lowenstein, 1991) which allows for the appropriate diagnosis of DID. Though supportive therapies provide a helpful foundation for DID patients, it is only after the correct diagnosis is made that adequate healing can occur.  DID, a condition that originates in childhood, is typically not diagnosed until patients are well into adulthood, if diagnosed at all.  The average patient is in psychotherapy for 7 years prior to the correct diagnosis of DID.

Because DID patients rarely volunteer information about dissociative symptoms, nor recognize their own dissociative tendencies, the absence of focused inquiry about dissociative processes prevents the actual diagnosis from being made. The reasons patients may present for treatment may be varied, often wit random and vague physical and psychological symptomatology.  Patients may present with complaints of impaired memory and concentration, but may report no significant history of trauma. Frequently, individuals with DID present as academically and professionally successful with strong interpersonal relationships.  Patients may not be able to give a clear picture about why they are seeking therapy.  They may remain in therapy, devoted to their therapist for many years, but without getting substantially better.

The 6% of the DID population that presents with overt symptoms are readily diagnosed, and may present in crisis or in hospital settings, for either psychological or physical reasons, as there is considerable overlap with this population. The professional challenge in diagnosing DID requires not only a thorough history, but focused questioning on the presence of DID symptoms, as well as the use of well designed assessment tools.

I have diagnosed, treated, and consulted about dozens of DID patients in over 20 years of practice.  With the exception of a few, all were diagnosed in their 30’s, 40’s or 50’s.  All had been in treatmenta with one or multiple therapists, frequently for a number of years; few presented with overt DID symptoms,.  As with many seasoned DID clinicians, I identified a couple of patients who were in my practice for a number of months or years before I recognized their dissociative disorder.

Dr. Elizabeth (Betsy) Schenk is a licensed psychotherapist with orientations in both Clinical Social Work and Clinical Psychology. Dr. Schenk maintains a full-time private psychotherapy office on Lake Merrit in Oakland  She is Faculty emeritus SFSU School of Social Work.  She has worked a behavioral health administator for adult and pediatric hospitals, and currently works extensively with survivors of trauma,  specializing in the treatment of dissociative disorders and vicarious trauma.  Dr. Schenk is a recognized  immigration forensic psychological expert  and has prepared psychosocial assessments and courtroom testimony for over 15 years.  She has lectured and provided organizational consulting to hospitals, child welfare agencies, legal agencies and health and mental health clinics. She has been providing clinical consultation and supervision for over 20 years.  Email:  drelizabethschenk@gmail.com;  525  Bellevue Avenue #319   Oakland  510-208-3450
 

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