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Doody's Review ServiceReviewer: Michael Joel Schrift, D.O., M.A.(University of Illinois at Chicago College of Medicine)
Description: This book purportedly covers schizophrenia, but it is primarily about the author's proposal to expand the dissociative disorders into the domain of schizophrenia and establish a dissociative subtype of schizophrenia. He makes, what I believe to be, an unsubstantiated claim that 25-40 percent of individuals in treatment for schizophrenia actually have a dissociative disorder. Indeed, patients with so-called dissociative identity (DID) disorder are reported to have Schneiderian first rank symptoms and other psychotic symptomatology, but they also have more of these symptoms than do individuals with schizophrenia; they have more depressive symptoms than do individuals with major depression; they have more manic symptoms than individuals with bipolar disorder; and they have more anxiety symptoms than individuals with anxiety disorders. The problem is that DID does not meet the validity criteria (Robins E, Guze SB Am J Psychiatry. 1970 Jan;126(7):983-7) for psychiatric disorders. Therefore, the "disorder" has no boundaries and could potentially expand to cover every psychiatric disorder. (For further discussion see Multiple Personalities, Multiple Disorders: Psychiatric Classification and Media Influence by North et al. (Oxford University Press, 1993)). The book is written by a well-known author in the field of dissociative disorders. I do not believe this book adds to the psychiatric literature or to our understanding of psychiatric nosology.
Purpose: The purpose of the book, according to the author, is to "attempt to define a subgroup of individuals within the DSM-IV-TR category of schizophrenia who are more likely to respond to psychotherapy, who are more likely to report severe childhood trauma, and who have more extensive comorbidity." (As if psychotherapy has been shown to be an effective treatment for DID.)
Audience: The book is aimed at clinicians and psychiatric researchers. According to the publisher's description of the book "...a must read for psychiatrists, psychologists, and other professionals involved in researching or treating schizophrenia."
Features: The first of the book's five parts covers the author's description of a dissociative subtype of schizophrenia. Part 2 covers psychosis and schizophrenia in reference to definitions, genetics, efficacy of antipsychotics, and psychological trauma as an etiology. Part 3 reviews DID. Part 4 summarizes the author's conception of the overlap between schizophrenia and DID. Part 5 focuses on treatment with chapters on outcome data, principles of psychotherapy for "dissociative schizophrenia," and lastly, a chapter on "talking to voices." There is a bibliography at the back of the book and the index is useful.
Assessment: I certainly believe that patients with DID suffer. It has been known since antiquity that patients with hysteria can have what appears to be epilepsy, paralysis, blindness, and multiple unexplained medical illnesses. They also can have "psychosis." Should we develop a dissociative subtype of epilepsy, stroke, and myocardial infarction?