Resident Education on Dissociative Identity Disorder: A National Survey

Abstract
Dissociative Identity Disorder (DID) is uniquely challenging to teach in residency because of its controversial status. For the past 40 years (since DSM-III) DID has been included in our official taxonomy however many psychiatrists still do not believe it exists. Clinical staff have widely disparate views of both the existence and the etiology of the disorder, however these conflicting views are often not discussed openly. Trainees in psychiatry are caught in the middle of these disparate views, without the necessary education or clinical exposure to form their own opinion. The aim of this study is to understand the current attitude towards DID in U.S. psychiatry residency programs and to quantify the teaching. A 12-item anonymous survey was sent through RedCap to general program directors in the United States. A total of 41 program directors participated in the survey with a response rate of 15% across a wide geographic distribution and program size.

Results showed that of the program directors who responded, 63% believe DID is a valid clinical diagnosis. Only 45% said that most psychiatrists in their department believed it is a valid diagnosis whereas 17% said that most do not. About a quarter of the programs do not teach residents about DID in didactic seminars and about a quarter do not teach about DID on clinical rotations.

Although the empirical literature on DID has expanded over the last 20 years, our data suggest that education on the topic is not ubiquitous in psychiatric residency. The risks of not teaching this topic well is significant in that graduate psychiatrists are at risk of 1) missing an opportunity for early diagnosis and intervention that could avoid prolonged patient suffering and disability, 2) treating the wrong disorder (such as psychosis) or only co-morbid conditions (such as BPD, PTSD) which is not effective and could be harmful, 3) inadvertently adding to escalating healthcare costs due to repeated or lengthy hospitalizations and 4) alienating patients --as well as their own clinical colleagues-- due to unwarranted skepticism, disbelief, or even contempt for the diagnosis.

The authors suggest that the goal of teaching about DID should not be centered around convincing residents that the disorder exists, but rather providing them with the evidence-based information to have an open mind despite the controversy. The limitations of this study include a small sample size and using an e-mail survey rather than direct interviews. Future directions are to collect quantitative and qualitative data from psychiatry residents themselves and to develop “best practices” in pedagogy of DID within the culture of medicine.