Dissociative Identity Disorder and the Registered Intermediary role - PowerPoint Presentation

1. Dissociative Identity Disorder and the Registered Intermediary role Dr. Brendan O’Mahony Professor Rebecca Milne Dr. Kevin Smith

2. In this sessionOverview of Registered Intermediary role (communication specialists)Overview of dissociative disorders (focusing on DID)The number of referrals to the Witness Intermediary Matching Service (England & Wales)Research findingsConcluding thoughts

3. Book: DCI Clive DriscollIn Pursuit of the Truthp237Sue opened the door and said, “Thank God you’ve come, Clive,’…she led me into the sitting room. The computer was a proper desktop job, big and square, and still plugged in, so I went over to unnhook everything – when suddenly there was this whack on the back of my shoulder. ‘What are you doing? Who are you? Get out of my ***** house!’ ‘Sue’, I said, ‘My name is DI Driscoll and I’m taking your computer away.’‘Why?’‘Because you asked me to.’‘Don’t you dare touch that computer or I’ll kill you.’Before I could do anything she flew at me...........‘It’s all right Clive, I’ll let you out,’ a female voice next to me said.‘Bonny?’‘Who else could it be? Thanks for coming. I really think this could make a difference.’

4. What is dissociation?A disruption of the usually integrated functions of consciousness, memory, identity or perception of the environmentWe all experience a degree of normal and benign dissociation, e.g. daydreaming while walking in the park (Kennedy et al 2013)A common view is that dissociation is a defence preventing emotionally unacceptable material from entering consciousness (but there are other views) Kennedy et al 2013

5. Dissociative DisordersDefinitions (DSM-V)Depersonalisation: experiences of unreality, detachment, or being an outside observer with respect to one’s thoughts, feelings, sensations, body, or actionsDerealisation: Experiences of unreality or detachment with respect to surroundings (individuals or objects are experienced as unreal, dreamlike, foggy, lifeless, or visually distorted)Dissociative Amnesia: an inability to recall important autobiographical information, usually of a traumatic or stressful nature, that is inconsistent with ordinary forgettingDissociative Identity Disorder (DID): Disruption of identity characterised by two or more distinct personality states. Recurrent gaps in the recall of everyday events, important personal information, and/or traumatic events that are inconsistent with ordinary forgetting. Symptoms cause clinically significant distress or impairment.

6. DID (also known as multiple personality disorder)HostsApparently Normal Personalities (ANPs)e.g. Judith aged 27 (Host)AltersEmotional Personalities (EPs)e.g.Jane aged 4 (Alter 1)Stephen aged 7 (Alter 2)Danni aged 14 (Alter 3)Jenny aged 40 (Alter 4)

7. Interviewing a person with DIDSachs (2015) p 73’Even though you only see one person sitting opposite you, remember that you are always talking to a group. The relationships between the members of the group range from friendliness to war. Some of those present are young children…many of the members…are not aware of other alters’

8. Referrals to the Witness Intermediary Team at the National Crime Agency (NCA)Time frame 1st January 2013 to 31st December 2015DID is not listed separately as a reason for referral; historically it has been combined under the category of Personality Disorders for the purpose of referral and matching with suitable intermediaryIn this time frame 251 cases have been identified where personality disorder was on the referral for service form from the NCACo-morbidities amongst these referrals including:79 also had a diagnosis of learning disability / intellectual disability 44 depression 18 autism 22 anxiety disorder19 bipolar affective disorder

9. DID casesCase 1: multiple personality disorder; dissociative personalities disorder; schizophrenia; bipolar affective disorderCase 24: personality disorders; self-harm; risk of suicide; 7 personalities; hallucinations and voicesCase 30: Dissociative Identity DisorderCase 34: Multiple Personality DisorderCase 37: Dissasociation (sic) Identity DisorderCase 91: 7 personalities, hallucinations and voicesCase 115: Multi Personality DisorderCase 166: Dissociative Identity DisorderCase 208: DID (Dissociative Identity Disorder)Case 215: Dissociative Identity Disorder

10. Other possible DID casesCase 73: Personality disorder; disassociation disorderCase 82: Dissociative DisorderCase 84: Dual personality disorderCase 87: PTSD; personality disorder; disassociation disorder; loses focus and attentionCase 106: Split personality disorderCase 140: Borderline split personality disorderCase 151: Split Personality DisorderCase 171: Split personality disorderCase 178: Split Personality DisorderCase 204: Disassociative (sic) disorder

11. Participants in this studyBOS Questionnaire distributed via Registered Intermediary intranet (RIO)5 Participants to date (research is ongoing)Professional backgrounds: nursing (1); psychology (1); social work (1); Speech & Language Therapy (1); prefer not to say (1)All participants: Very limited experience (if any) of working with DID cases prior to becoming a Registered Intermediary. Aren’t we supposed to be communication specialists?

12. Findings

13. Range of formal / informal assessments used by participants‘No formal assessment tools used: The focus of the assessment was largely practical. Who are the alters? What triggers them? How are they noticeable?’‘Informal discussing difficulties / alters in detail as an able communicator’‘Assessment of understanding and language in a second case (a woman in her 40s) as one of her alters, that of a 4 year old child, was the alter present in the majority of the assessment.’

14. Difficulties encountered in assessment‘Multiple issues. Establishing what strategies, if any, could assist the witness to return to her base personality. PTSD type symptoms whenever the witness was triggered by something being discussed, for example, whenever childhood was mentioned.’‘Explaining to the IO that telling the witness to calm down / have a break / tell the truth, was not helpful’‘Trying to establish recognition by the intermediary for the different personalities which might appear’‘As it was such an unknown area, it often felt like we were second-guessing how to approach the whole issue’‘Lack of clarity on how to proceed with the assessment when alters were present’

15. Advice given to IO following assessment‘Acknowledging ‘X’s’ presence; greeting the alter and then asking if ‘Y’ could return (the base personality) to continue’‘Allowing for breaks whenever the intermediary needed to re-establish integration and the base personality’s presence / or to deal with evident trauma or for the IO themselves to use agreed techniques to re-establish integration’‘Long discussion with senior officers and advisors on one occasion to try to establish a method of interviewing which would provide acceptable evidence’‘Discussed extensively with NCA Interview Advisor: decided that the witness could only give evidence when in ‘ANP’; and when ‘alt’ was in control the evidence should be stopped.’

16. Interventions used during police interview‘Frequent interventions in one case where one of the ‘child’ alters became extremely traumatised and exhibited much disturbed child behaviour. Another was extremely naughty; trying to tear things up / throwing / refusing to co-operate etc. It was almost impossible to re-integrate her; and identify contact with her base personality to continue the interview. An ABE interview giving a clear account of what she remembered happening in her base personality was eventually obtained over many hours.’‘In another case she was able to stay in her base personality throughout the interview – but needed frequent breaks ‘so that others could tell her what to say next’

17. Number of Alters (Emotional Personalities - EPs) present at assessment / interviewCase 1: Not witnessed but believed to be 7 from self-reportCase 2: 3 (1 witnessed)Case 3: 43 (1 witnessed)Case 4: 16Case 5: 10Case 6: 1

18. Court reports / attending courtNone of the participants have written reports for court or attended DID cases at courtOne participant has provided peer support and mentoring for a colleague who has attended court with a DID case

19. Do RIs need specific qualifications, training and experience in working with DID cases, prior to accepting referrals from WIT?‘Yes, I do feel that it would be most beneficial for RIs to have specific training and qualifications to deal with such cases as they are extremely complex and challenging and unique...’‘Yes! It is a radically different disorder creating unique problems. Most people working in the CJS will never have heard of it, never mind dealt with a case so will be looking for the RI to have knowledge of the potential communication issues. There are many people in the psychiatric field who do not believe the disorder exists…conversely a DID Institute in London which provides Expert Witness reports insisting that at court every ‘alter’ has to be dealt with and listened to and cross-examined which can further confuse the situation’‘Definitely’

20. General comments‘Developing our understanding of DID within a small group of ‘experts’ will enable the RI service to provide a top quality service to both the witnesses who need it and to the end user who requests it’‘I’m not at all sure that we should be co-operating in attempting to take people with DID profiles to court until there has been a proper discussion at high legal levels to establish on what basis the court can accept evidence’‘I think the RI has a function with DID cases and can identify when an Alt is present. The main issue in the case I worked on was the lack of clarity as to whether a witness can give evidence as an ‘alter’ when they are subsequently unable to recall what they have said as ‘ANP’. So, the lack of clarity is on a wider legal level, rather than at the RI level’

21. Concluding thoughtsThis research is making us acutely aware of the complexity of mental health issues in investigative interviewingAt a general level it reminds us of the dearth of literature in this areaDo we need to investigate further how dissociation is identified / managed in investigative interviews? (including children’s interviews)DID is highly complex and there is a lack of guidance to RIsAre RIs the answer or could mental health workers with expertise in DID be of more benefit at investigative interview / court?What is the legal framework here? What is the best way to enable a vulnerable witness with DID to give their account(s)? Should we dictate whether the ANP or the EP(s) is best placed to give the account? Surely the criminal justice system should be examining the literature before making these decisions?

22. ReferencesKennedy, F., Kennerley, H. & Pearson, D. (2013). Cognitive Behavioural Approaches to the Understanding and Treatment of Dissociation. RoutledgeSachs, A. (2015). Who Done It, Actually? Dissociative Identity Disorder for the Criminologist. International Journal for Crime, Justice and Social Democracy, 4 (2), 65-76Working with Traumatised Witnesses, Defendants and Parties. The Advocate’s Gateway, Toolkit 18

23. Contact detailsDr. Brendan O’Mahonyinfo@cjspsychology.com