Canadian and American Psychiatrists' Attitudes Toward Dissociative Disorders Diagnoses
Justine K Lalonde, MD1, James I Hudson, MD, SM2, Robin A Gigante, BA3, Harrison G Pope Jr, MD, MPH4
Objective: To compare the opinions of Canadian psychiatrists regarding dissociative
disorder diagnoses with those of previously surveyed American psychiatrists.
Method: We sent a 1-page questionnaire to a stratified representative sample of 550 Canadian psychiatrists.
Results: Eighty percent of Canadian psychiatrists responded. Fewer than one-third replied that dissociative amnesia and dissociative identity disorder should be included without reservations in the DSM-IV; fewer than 1 in 7 felt that the validity of these diagnoses was supported by strong scientific evidence. French- and English-speaking Canadians had similar opinions. Overall, Canadians were significantly less accepting than Americans.
Conclusions: Both Canadian and American psychiatrists show little consensus regarding the diagnostic status or scientific validity of dissociative amnesia and dissociative identity disorder.
(Can J Psychiatry 2001;46:407-412)
Key Words: dissociative amnesia, dissociative disorders, dissociative identity disorder, DSM classification
Controversy surrounds the diagnoses of “dissociative amnesia” and “dissociative identity disorder” (also known as “multiple personality disorder”). The American Psychiatric Association’s DSM-IV (1) recognizes both as official diagnostic categories, a fact sometimes cited as evidence of general acceptance (2). By contrast, the World Health Organization’s International Classification of Diseases, 10th Revision (ICD-10) (3,4) is more skeptical, classifying dissociative disorders as conversion disorders and suggesting that dissociative identity disorder may be “a culture-specific or even iatrogenic condition” (3, p 15).
Manuscript received September 2000 and accepted March 2001.
Even within the US, where the DSM-IV is widely used, a survey of psychiatrists found little consensus regarding these diagnoses, with only about one-third of respondents answering that dissociative amnesia and dissciative identity disorder should be included withouth reservations in the DSM-IV (5). Fewer than one-quarter felt that strong scientific evidence supported their validity.
To expand our study, we surveyed a representative national sample of Canadian psychiatrists. We sought to test 3 hypotheses: 1) that French-speaking Canadian psychiatrists are less accepting of dissociative disorder diagnoses than are their English-speaking counterparts, given the dearth of literature in French supporting these entities (6); 2) that Canadian psychiatrists as a whole are less accepting than are American psychiatrists, given evidence that the British Commonwealth literature has generally been more critical of the concept of dissociative disorders (7); and 3) that, as in the US, psychodynamically-oriented Canadian psychiatrists are more accepting of dissociative disorders than are biologically-oriented ones.
We identified Canadian psychiatrists by consulting the Canadian Medical Directory (8), which lists certified psychiatrists alphabetically by town, borough, and city within each province.