27 J. Psychiatry & L. 423 (1999)
Imitation of Dissociative Identity Disorder: Patients at Risk, Therapists at Risk, The; Draijer, Nel; Boon, Suzette

handle is hein.journals/jpsych27 and id is 433 raw text is: The Journal of Psychiatry & Law 27/Fall-Winter 1999

The imitation of dissociative
identity disorder: patients
at risk, therapists at risk
BY NEL DRAIJER, PH.D.
AND SUZETTE BOON, PH.D.
Since the late 1980s the authors have been confronted with cases
of imitated dissociative identity disorder (DID) in Holland. Because
DSM-IV defines factitious disorder as intentional, the term
imitation of DID is used here for patients who, partly
unconsciously motivated, simulate a DID profile. DID can be
imitated due to contagion, to iatrogenesis, or to both. The core
dynamics are: (1) the avoidance of responsibility for negative
behavior, found mostly in patients with a borderline or
antisocial personality disorder; and (2) the compensation for
an overwhelming feeling of not being seen. The last, hysterical,
dynamic is characterized by identity disturbances varying in
severity according to the underlying borderline personality
structure. Four cases are described. Differentiating between
genuine and imitated DID requires systematic assessment by an
experienced clinician. Even then this is difficult, in particular
differentiating between flamboyant genuine DID, with coexisting
histrionic personality disorder (a minority of patients with genuine
DID), and simulated cases. Diagnostic and treatment implications
are discussed.
Since the late 1980s the authors have been confronted with
cases of simulated dissociative identity disorder (DID) in
Holland.' These patients were found in the mental health care

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