Objective documentation of child abuse and dissociation in 12 murderers with dissociative identity disorder.
OBJECTIVE
The skepticism regarding the existence of dissociative identity disorder as well as the abuse that engenders it persists for lack of objective documentation. This is doubly so for the disorder in murderers because of issues of suspected malingering. This article presents objective verification of both dissociative symptoms and severe abuse during childhood in a series of adult murderers with dissociative identity disorder.


METHODS
This study consisted of a review of the clinical records of 11 men and one woman with DSM-IV-defined dissociative identity disorder who had committed murder. Data were gathered from medical, psychiatric, social service, school, military, and prison records and from records of interviews with subjects' family members and others. Handwriting samples were also examined. Data were analyzed qualitatively.


RESULTS
Signs and symptoms of dissociative identity disorder in childhood and adulthood were corroborated independently and from several sources in all 12 cases; objective evidence of severe abuse was obtained in 11 cases. The subjects had amnesia for most of the abuse and underreported it. Marked changes in writing style and/or signatures were documented in 10 cases.


CONCLUSIONS
This study establishes, once and for all, the linkage between early severe abuse and dissociative identity disorder. Further, the data demonstrate that the disorder can be distinguished from malingering and from other disorders. The study shows that it is possible, with great effort, to obtain objective evidence of both the symptoms of dissociative identity disorder and the abuse that engenders it.
Lewis
D O
DO
Department of Psychiatry, New York University School of Medicine, New York, NY 10016, USA.
Yeager
C A
CA
Swica
Y
Y
Pincus
J H
JH
Lewis
M
M
D000328:Adult; D002648:Child; D002649:Child Abuse / Q000175:diagnosis* / Q000706:statistics & numerical data; D002650:Child Abuse, Sexual / Q000175:diagnosis / Q000706:statistics & numerical data; D015897:Comorbidity; D003937:Diagnosis, Differential; D004213:Dissociative Disorders / Q000175:diagnosis / Q000453:epidemiology; D009105:Dissociative Identity Disorder / Q000175:diagnosis* / Q000453:epidemiology; D005260:Female; D005555:Forensic Psychiatry; D006236:Handwriting; D006708:Homicide; D006801:Humans; D008297:Male; D008306:Malingering / Q000175:diagnosis / Q000453:epidemiology / Q000523:psychology; D011329:Prisoners / Q000523:psychology*