Factitious disorder & MPD & DID – Why non disordered Plurals do not have factitious disorder

We are the Stronghold system and we are diagnosed with Dissociative Identity Disorder. We also self ID as Plural. We are the founders of The Plural Association, a nonprofit that serves people with Dissociative Identity Disorder and all other forms of plurality, worldwide.
Before we dive deep into factitious disorder, let’s first have a look at the DSM-3.

MPD:

In 1980 the DSM-3 was released and with that Multiple Personality Disorder (MPD) was now something that could be diagnosed.
The three part diagnostic criteria were simple and looks a lot like what non disordered plurals experience: 
A, the existence of two or more distinct personalities.
B, each personality is unique with its own behaviour patterns and relationships.
C, the personality that is dominant at any particular time determines the individuals behaviour.

Multiple Personality Disorder did not require distress or amnesia,
but is not considered factitious disorder:

That was all that was needed to be diagnosed with MPD. This led to some significant issues. I’d like to mention a few here. One, we are not personalities. Two, we know the experience of DID can be a very covert one as the current DSM-5 mentions. So criteria B could be hard to observe or might even lead to some people acting out.

By that i mean exaggerate the signs and symptoms they experience, in order to get validated. Three we now know there is co-consciousness and passive influence which is clearly not reflected in the last criteria of MPD. You could technically not heal from MPD without final fusion integration. You stayed labeled disordered (MPD) unless you no longer had ‘personalities.’ 

MPD & factitious disorder:

Another issue with MPD is that there is no mention of amnesia, distress or impairment. So even if you live a healthy and stable life with your alters, you would still be labeled disordered (MPD) if you were to visit a therapist back then and spoke there in any capacity about your other personalities as we were called back then. What MPD looked like was that anyone who expressed Plurality, by that i mean Manyness, would get diagnosed and labeled disordered. Although the DSM updated, it does not imply that non disordered systems must have factitious disorder.

The Diagnostic Statistical Manual – DSM

As you can see in this fantastic image above, provided by Liberty of the Sorority, a lot has changed since the 80’s. These days people need to experience a form of out of the ordinary forgetting and the symptomes must cause clinically significant distress to qualify for a diagnosis. You could say that back in the 80’s anyone Plural was considered disordered. But these days, we know there are non disordered Plurals and they do not experience amnesia nor does their Plurality cause them significant distress and hence these people experience Manyness but they do not have DID.

Many of these people try to find community and people with similar experiences. Some call themselves voice hearers others use beautiful words like quoigenic to label their experience. Most of them found out they are having these experiences in the same way as us finding out we have DID. It can be scary, overwhelming and certainly confusing. Yet beautiful at the same time. Like puzzle pieces falling into place.

Disordered or not disordered:

Besides that MPD was a disorder, it covers Plurality as un umbrella a lot better then DID does. Which is okay cause many Plurals are not disordered, nor do they wish to be labeled that way. Factitious disorder, is just that, a disorder!

So someone could meet criteria A for DID in the DSM-5 but not the other criterias. That means they do not have a dissociative disorder, they do not have DID, but they are Many. The dsm-5 mentions cultural and religious cases of multiplicity often. It excludes it from a DID diagnosis. But it does in no way invalidate these people their existence or experience. So why should we?!

Endogenic systems:

I especially see a lot of hate towards Endogenic systems. Endogenic is an umbrella term for anyone who doesn’t attribute trauma towards their Plurality, you can read more about the origin of Endogenic label by clicking here. It doesn’t mean these people haven’t experienced trauma, some definitly have and making assumptions or catagorizing and trauma weighing others their experiences isn’t ethical. Many believe that they were Plural before any trauma could have ever happened. Something Putnam and Structural Dissociation confirm. Some people have said that those people then must have factitious disorder, this article aims to explain how can’t be the case.

Factitious disorder:

There are four primary criteria for diagnosing factitious disorder. These are:
A, Intentional induction or falsification of physical or psychological signs or symptoms.
B, The individual presents themselves as ill, impaired or injured to others.
C, The deceptive behavior persists even in the absence of external incentives or rewards.
D, Another mental disorder does not better explain the behavior.

Malingering:

But as you can see criteria B for factitious disorder clearly states they need to assume the sick role. And these people do not claim that whatsoever. They (rightfully) claim that they are not disordered instead. Well maybe they are malingering?

I do not see how people can get financial or other gain from this. They are not on disability (for DID) and stories of avoiding criminal conviction while claiming Plurality or Manyness instead of DID is something yet to happen. I’d be surprised if it does, but keep me posted. 

Manyness:

So they do not have factitious disorder, nor are they malingering. They have the experience of Manyness and that experience is extremely valid. First of all because it is an experience they have and secondly because criteria A says they can self report signs and symptoms. They label that experience depending on culture, age, background and so much more. It is not up to us to label other people their experience. Or to demand what the experience should look like. It’s our job to be inclusive of everyone with a similar experience of Manyness. We all know how lonely it can be. Disordered or not. If we do not get to diagnose people with DID, we also cannot diagnose them with factitious disorder, both is unethical. 

Trauma:

Suggesting or worse demanding, that trauma has to be part of the Plural experience is unethical and really not appreciated in our communities as it is suggestive and gatekeeping. It’s something therapists are told and trained not to do. So who are we, to do so instead. In the case of DID, all these years protectors worked hard to keep it a secret. It is never up to us to disclose that information. It could lead to flooding and we can’t help people in crisis. It’s what the lawsuits in the 90’s were about. Let’s not repeat those mistakes. It is not a diagnostic criteria. It could also very well be that someone joins a DID group but is Plural or what ever other label they use for Manyness instead. So it is safest and most ethical to not make the assumption.

Soul searching & selves discovery:

It’s okay to soul search, it’s okay to self discover. It’s often still the fastest (if not the only) way to find out if you experience Manyness. Because getting a DID diagnosis takes 6 to 12 years if we believe research. Self reporting can speed that process up. To do that, you will have to look inside first. It’s okay to try to discover if you are Plural or have DID and then find out that your experience actually is different. It’s okay to be confused, to change your opinion, labels, vision, beliefs or ideas.

It’s okay:

It’s okay to follow your own path. It’s okay to change your labels. It’s okay to try to get help from a therapist and it’s okay to not do that. It’s okay to hold on to what still feels most comfortable, including the labels you use to self express and/or identify with. Please, do not allow anyone outside of you to define you. To label you as something you are not. Self identify how you feel most comfortable. It’s 2019, we celebrate our individuality & diversity in our Plurality. And we choose to do it by being inclusive of all. Whether you are/or identify as Multiple or Endogenic, DID, Plural or something else, you & your experiences are valid and we believe you.