document_title: Three-point field goal

question_text: when was the three point shot added to basketball

root

text: Three-point field goal

text: History[edit]

text: The three-point line was first tested at the collegiate level in a 1945 NCAA game between Columbia and Fordham but it was not kept as a rule. At the direction of Abe Saperstein, the American Basketball League became the first basketball league to institute the rule in 1961. Its three-point line was a radius of 25 feet (7.62 m) from the baskets, except along the sides.[2] The Eastern Professional Basketball League followed in its 1963–64 season.

tag: p

text: The three-point shot later became popularized by the American Basketball Association (ABA), introduced in its inaugural 1967–68 season. ABA commissioner George Mikan stated the three-pointer "would give the smaller player a chance to score and open up the defense to make the game more enjoyable for the fans."[3] During the 1970s, the ABA used the three-point shot, along with the slam dunk, as a marketing tool to compete with the National Basketball Association (NBA).

text: In the 1979–80 season, after having tested it in the previous pre-season, the NBA adopted the three-point line despite the view of many that it was a gimmick.[4] Chris Ford of the Boston Celtics is widely credited with making the first three-point shot in NBA history on October 12, 1979, a game more noted for the debut of Larry Bird (and two new head coaches).[5][6] Rick Barry of the Houston Rockets, in his final season, also made one in the same game, and Kevin Grevey of the Washington Bullets made one that Friday night as well.[6][7]

text: The sport's international governing body, FIBA, introduced the three-point line in 1984, at 6.25 m (20 ft 6 in).

text: The NCAA's Southern Conference became the first collegiate conference to use the three-point rule, adopting a 22-foot (6.71 m) line for the 1980–81 season.[8][9] Ronnie Carr of Western Carolina University was the first to score a three-point field goal in college basketball history on November 29, 1980.[9][10][11] Over the following five years, NCAA conferences differed in their use of the rule and distance required for a three-pointer. The line was as close as 17 ft 9 in (5.41 m) in the Atlantic Coast Conference (ACC), and as far away as 22 ft (6.71 m) in the Big Sky.[12][13][14]

text: Used only in conference play for several years, it was adopted by the NCAA in April 1986 for the 1986–87 season at 19 ft 9 in (6.02 m),[15] and was first used in the NCAA Tournament in 1987.[16] In the same 1986–87 season, the NCAA adopted the three-pointer in women's basketball on an experimental basis, using the same distance, and made its use mandatory beginning in 1987–88.[17]  In 2007, the NCAA lengthened the men's distance by a foot to 20 ft 9 in (6.32 m), effective with the 2008–09 season,[18] and the women's line was moved to match the men's in 2011–12.[17] American high schools, along with elementary and middle schools, adopted a 19 ft 9 in (6.02 m) line nationally in 1987, a year after the NCAA.[19] The NCAA used the FIBA three-point line (see below) in the National Invitation Tournament (NIT) in 2018.[20]

text: During the 1994–95, 1995–96, and 1996–97 seasons, the NBA attempted to address decreased scoring by shortening the distance of the line from 23 ft 9 in (7.24 m) (22 ft (6.71 m) at the corners) to a uniform 22 ft (6.71 m) around the basket. From the 1997–98 season on, the NBA reverted the line to its original distance of 23 ft 9 in (22 ft at the corners, with a 3 inch differential). Ray Allen is currently the NBA all-time leader in career made three-pointers with 2,973.[21]

text: In 2008, FIBA announced that the distance would be increased by 50 cm (19.69 in) to 6.75 m (22 ft 1 3⁄4 in), with the change being phased in beginning in October 2010. In December 2012, the WNBA announced that it would be using FIBA's distance, too, as of the 2013 season. The NBA has discussed adding a four-point line, according to president Rod Thorn.[22]

text: In the NBA, three-point field goals have become increasingly more frequent along the years, with effectiveness increasing slightly. The 1979-80 season had an average 2.2 three-point goals per game and 6.6 attempts (33% effectiveness). The 1989-90 season had an average 4.8 three-point goals per game and 13.7 attempts (35% effectiveness). The 2009-10 season had an average 6.4 three-point goals per game and 18.1 attempts (36% effectiveness). The 2016-17 season had an average 9.7 three-point goals per game and 27.0 attempts (36% effectiveness).[23]

text: Rule specifications[edit]

text:
A three-point line consists of an arc at a set radius measured from the point on the floor directly below the center of the basket, and two parallel lines equidistant from each sideline extending from the nearest end line to the point at which they intersect the arc. In the NBA and FIBA standard, the arc spans the width of the court until it is a specified minimum distance from each sideline. The three-point line then becomes parallel to the sidelines from those points to the baseline. The unusual formation of the three-point line at these levels allows players some space from which to attempt a three-point shot at the corners of the court; the arc would be less than 2 feet (0.61 m) from each sideline at the corners if it was a continuous arc. In the NCAA and American high school standards, the arc spans 180° around the basket, then becomes parallel to the sidelines from the plane of the basket center to the baseline (5 feet 3 inches or 1.60 metres).
The distance of the three-point line to the center of the hoop varies by level:

text:
Arc radius

Minimum distance from sidelines

National Basketball Association

23 feet 9 inches (7.24 m)

3 feet (0.91 m)

[24]

FIBA (also used by WNBA)

22 feet 2 inches (6.76 m)

4 feet 1 inch (1.24 m)

[25]

National Collegiate Athletic Association

20 feet 9 inches (6.32 m)

4 feet 3 inches (1.30 m)

[26]

American high school basketball

19 feet 9 inches (6.02 m)

5 feet 3 inches (1.60 m)

[27]

tag: table

text: A player's feet must be completely behind the three-point line at the time of the shot or jump in order to make a three-point attempt; if the player's feet are on or in front of the line, it is a two-point attempt. A player is allowed to jump from outside the line and land inside the line to make a three-point attempt, as long as the ball is released in mid-air.

text: An official raises his/her arm with three fingers extended to signal the shot attempt. If the attempt is successful, he/she raises his/her other arm with all fingers fully extended in manner similar to a football official signifying successful field goal to indicate the three-point goal. The official must recognize it for it to count as three points. Instant replay has sometimes been used, depending on league rules. The NBA,[28] WNBA, FIBA and the NCAA specifically allow replay for this purpose. In NBA, FIBA, and WNBA games, video replay does not have to occur immediately following a shot; play can continue and the officials can adjust the scoring later in the game, after reviewing the video. However, in late game situations, play may be paused pending a review.

text: If a shooter is fouled while attempting a three-pointer and subsequently misses the shot, the shooter is awarded three free-throw attempts. If a player completes a three-pointer while being fouled, the player is awarded one free-throw for a possible 4-point play. Conceivably, if a player completed a three-pointer while being fouled, and that foul was ruled as either a Flagrant 1 or a Flagrant 2 foul, the player would be awarded two free throws for a possible 5-point play.

text: Related concepts[edit]

text: Major League Lacrosse features a two-point line which forms a 15-yard (14 m) arc around the front of the goal. Shots taken from behind this line count for two points, as opposed to the standard one point.

text: In gridiron football, a standard field goal is worth three points; various professional and semi-pro leagues have experimented with four-point field goals. NFL Europe and the Stars Football League adopted a rule similar to basketball's three-point line in which an additional point was awarded for longer field goals; in both leagues any field goal of 50 yards (46 m) or more was worth four points. The Arena Football League awards four points for any successful drop kicked field goal (like the three-point shot, the drop kick is more challenging than a standard place kick, as the bounce of the ball makes a kick less predictable, and arena football also uses narrower goal posts for all kicks than the outdoor game does).

text: During the existence of the World Hockey Association in the 1970s, there were proposals for two-point hockey goals for shots taken beyond an established distance (one proposal was a 44-foot (13.4m) arc, which would have intersected the faceoff circles), but this proposal gained little support and faded after the WHA merged with the NHL. It was widely believed that long-distance shots in hockey had little direct relation to skill (usually resulting more from goalies' vision being screened or obscured), plus with the lower scoring intrinsic to the sport a two-point goal was seen as disruptive of the structure of the game.

text: The Super Goal is a similar concept in Australian rules football, in which a 50-meter (55 yd) arc determines the value of a goal; within the arc, it is the usual 6 points, but 9 points are scored for a "super goal" scored from outside the arc. To date the super goal is only used in pre-season games and not in the season proper.[29]

text: The National Professional Soccer League II, which awarded two points for all goals except those on the power play, also used a three-point line, drawn 45 feet (14 m) from the goal. It has since been adopted by some other indoor soccer leagues.


document_title: Holy Spirit in the Acts of the Apostles

question_text: how many times is the holy spirit mentioned in the book of acts

text: Holy Spirit in the Acts of the Apostles

text: The Holy Spirit plays a key role in the Acts of the Apostles, leading to the use of the titles "Book of the Holy Spirit" or the "Acts of the Holy Spirit" for that book of the New Testament.[1][2] Of the about seventy occurrences of the word Pneuma in Acts, fifty five refer to the Holy Spirit.[2]

text: From the start, in Acts 1:2, the reader is reminded that the Ministry of Jesus, while he was on earth, was carried out through the power of the Holy Spirit and that the "acts of the apostles" are the continuing acts of Jesus, facilitated by the Holy Spirit.[2] Acts thus presents the Holy Spirit as the "life principle" of the early Church and provides five separate and dramatic instances of its outpouring on believers in 2:1-4, 4:28-31, 8:15-17, 10:44 and 19:6.[1]

text: Also Stephen in Acts 7 reproachfully exclaims to the Jewish authorities—see Sanhedrin trial of Jesus: "Ye stiffnecked and uncircumcised in heart and ears, ye do always resist the Holy Ghost: as your fathers did, so do ye." Acts 7:51 (KJV)—That means, as nobody ever told them before, they did not only resisted YHWH or Jesus, while he was on earth, but they resisted the Holy Spirit also thereafter! It reminds oneself about the sin against the Holy Spirit, which Jesus taught, that ascribing the miracles of Jesus to the devil, it is resisting the Holy Spirit's work through the life of Jesus. The context of the unpardonable sin is best described in this passage:

text: "The scribes who came down from Jerusalem were saying, "He is possessed by Beelzebul," and "He casts out the demons by the ruler of the demons." And He called them to Himself and began speaking to them in parables, "How can Satan cast out Satan? If a kingdom is divided against itself, that kingdom cannot stand. If a house is divided against itself, that house will not be able to stand. If Satan has risen up against himself and is divided, he cannot stand, but he is finished! But no one can enter the strong man's house and plunder his property unless he first binds the strong man, and then he will plunder his house. "Truly I say to you, all sins shall be forgiven the sons of men, and whatever blasphemies they utter; but whoever blasphemes against the Holy Spirit never has forgiveness, but is guilty of an eternal sin"—because they were saying, "He has an unclean spirit."" (Mark 3:22-30 (NASB))

text: The resistance of the Jews against the Holy Spirit has already been taught by Jesus. This was like a surprise for the Jews, since they believed they had been following YHWH. They may have been following his name, but, not his Spirit and not Jesus teachings about Love God and your neighbor as yourself. They have followed the part of Deuteronomy, but not the second part of Leviticus (Deut.6:3;Lev.3:1 (NASB). Jesus was the first in history to bring the two Bible passages to the point! Mark 12:30-31 (KJV): "And thou shalt love the Lord thy God with all thy heart, and with all thy soul, and with all thy mind, and with all thy strength: this is the first commandment. And the second is like, namely this, Thou shalt love thy neighbor as thyself. There is none other commandment greater than these." But if the young ruler knew it, why did the Pharisees and the Scribes not see it? They then were the same ones who stoned Stephen and instigated Herod to put James, brother of Jesus, to death by the sword (Eusebius writes: beheaded), Saint Peter into jail (Herod Agrippa I, a pagan, nominally a Jew by the conversion to Judaism from before his grandfathers time, Herod the Great),[3] and his nephew Herod Antipas had beheaded John the Baptist and had Jesus sent back to Pontius Pilate, who was more favorable to Jesus than the Jews, but had to submit to the instigated crowd, because he wanted to let him go free at first (they were all converts form paganism to nominal Judaism, trying to please the Jews (Acts 12:3 Study Bible).[4] So, the Herodians were resisting the Holy Spirit too.

text: References to the Holy Spirit appear throughout Acts 1:5 and 8 stating towards the beginning: "For John indeed baptized with water; but ye shall be baptized in the Holy Spirit ... ye shall receive power, when the Holy Spirit is come upon you" referring to the fulfillment of the prophecy of John the Baptist in Luke 3:16: "he shall baptize you in the Holy Spirit".[5]

text: In addition to the Holy Spirit and in its impacts on the Book of Acts, this should include the Lord's direct communication to Paul. This encounter had a very pivotal in terms of Paul's defense against the Roman Empire and Jewish authority empowered by the Holy Spirit. Several passages, for example, Acts 9:1-9, Acts, 18:10, Acts 23:11, and Acts 27:23 all reveal a pneumatological element that reshapes the outcome of Paul's trial bending towards the prevailing of God's will rather than the agony of Paul's death.


document_title: Leave Out All the Rest

question_text: when does leave out all the rest play in twilight

text: Leave Out All the Rest

text: Background information[edit]

text: The song's working titles were "Fear" and "When My Time Comes" according to the booklet. While writing, the group went through over thirty lyrical variations before completing the album version. The song combines various synths and samples with raw guitars and drums and powerful vocals. A demo which features Mike Shinoda doing lead vocals can be heard on the Making of Minutes to Midnight documentary, as well as the Linkin Park Underground 9.0 CD where it is entitled "Fear". The song starts with a string sample and electric piano intro, followed by the verse. At the end of the song of the album version, a crowd can be heard which leads into "Bleed It Out", a song that features the background sound of a crowd throughout.

text: In a Kerrang! review/interview of the band, and the album, vocalist Chester Bennington had this to say about the song, "We knew this was going to be a single from the very beginning, so we worked really hard on making sure it had great lyrics. I'm singing 'Pretending someone else can come and save me from myself' during it because it's supposed to feel like an apology letter, as though I'm moving on but I want people to remember the good things and not the bad things. A lot of the song is about humility."[5] Mike Shinoda has also stated that Rick Rubin (producer for Minutes to Midnight) was the first to have said "This sounds like a massive single".

text: Media appearances[edit]

text: The intro to the song was featured on an English advert for the US television series Law & Order for Sky One.[citation needed]

text: It was also featured on the original motion picture soundtrack for the 2008 film Twilight. It is played during the end credits. Also, the performance from "Road to Revolution" is available on the Twilight special edition DVD.

text: "Leave Out All the Rest" was the title of a CSI episode that aired on November 6, 2008. The band made a deal with CBS to work the song into the episode. It contained several elements of the song throughout, and pieces of the verses, as well as the chorus, were played at the opening and end of the episode.[6]

text: In 2011 the German action-series Alarm für Cobra 11 used a part of the song (the chorus) in an especially sad scene, it was the fifth time that a Linkin Park title was used in the series.

text: Music video[edit]

text: In an interview with MTV, Mike said that the video, directed by bandmate Joe Hahn, takes place in a futuristic, science fiction influenced setting, and depicts what the daily life of the band's members would be like if they lived in outer space. The band lives in a rundown, artificial habitat that is making its way across the galaxy. At first, they are seen passing the time performing mundane tasks, but then gravity is lost on board the vessel, sending the members floating into what looks like the Sun or a star. The video features no performance footage, though Chester Bennington is seen singing during most of his solo scenes.[7] The video has respectively been influenced by the British movie Sunshine, borrowing similar imagery and a similar concept. Hahn said:

text: We're explorers in space, just like when we go on tour. We're leaving our home life behind, and I guess it kind of ties into 'Leave Out All the Rest', in that we have to leave things behind in order to do something better.

text: The video leaked on May 30, 2008, the same day the band released a statement on their widget at MySpace, saying that the premiere for the video would be on June 2, 2008. It featured in the top ten songs of the week on VH1.[8][9][10][11][12]

text: While playing a show in Germany (München) in June 2008, Shinoda spoke with Warner Bros. Records Germany and they told him that the music video they've made for "Leave Out All the Rest" was not going to be released just yet due to the high success for the single "Given Up" in Germany. He later told this to the fans at the show.[13][14]

text: Chart performance[edit]

text: The song managed to spend one week on the Billboard Pop 100 without being officially released as a single, at #98.[15] The song debuted on the US Billboard Hot Modern Rock Tracks at #35 and peaked at #11. It is one of Linkin Park's lowest charting songs in the UK to date, peaking at #90, as well as on the Billboard Modern Rock chart, peaking at only #11. "Leave Out All the Rest" debuted on the Billboard Hot 100 at #99 and the Billboard Hot Digital Songs at #72. The single would later peak on the Billboard Hot 100 at #94. Despite its mediocre chart performance, the single was still certified Gold by the RIAA in 2009, and later reached Platinum in 2017.

text: Track listings[edit]

text:
CD single • iTunes single

No.
Title
Length

1.
"Leave Out All the Rest"
3:19

2.
"In Pieces" (Live from Projekt Revolution, Washington DC, Aug. 19 '07)
3:47

text: All tracks written by Linkin Park.

text:
Maxi single

No.
Title
Length

1.
"Leave Out All the Rest"
3:19

2.
"In Pieces" (Live from Projekt Revolution, Washington DC, Aug. 19 '07)
3:47

3.
"Leave Out All the Rest" (Live from Projekt Revolution, Detroit MI, Aug. 22 '07)
3:26

4.
"Leave Out All the Rest" (Video)

text: All tracks written by Linkin Park.

text:
Japanese single

No.
Title
Length

1.
"Leave Out All the Rest"
3:19

2.
"Leave Out All the Rest" (Live from Projekt Revolution, Detroit MI, Aug. 22 '07)
3:26

3.
"L.O.A.T.R." (M. Shinoda Remix)
3:46

4.
"Leave Out All the Rest" (Video)
3:25

5.
"Leave Out All the Rest" (Live Video)
3:27

text: All tracks written by Linkin Park.

text:
iTunes EP

No.
Title
Length

1.
"Leave Out All the Rest"
3:19

2.
"In Pieces" (Live from Projekt Revolution, Washington DC, Aug. 19 '07)
3:47

3.
"Leave Out All the Rest" (Live from Projekt Revolution, Detroit MI, Aug. 22 '07)
3:26

text: Chart positions[edit]

text:
Chart (2007)
Peak
position

US Billboard Pop 100
98

US Billboard Bubbling Under Hot 100
17

Chart (2008)
Peak
position

Argentinian Singles Chart
46

Australian ARIA Singles Chart
24

Austrian Singles Chart[16]
17

Brazil (ABPD)[17]
55

Czech Singles Chart[16]
12

European Hot 100 Singles[18]
54

Finland Singles Chart[16]
19

German Singles Chart[16]
15

New Zealand RIANZ Singles Chart
38

Polish Singles Chart[19]
3

Portugal Airplay Chart[20]
5

Slovakia Singles Chart[16]
12

Swiss Singles Chart[16]
36

Turkey Top 20 Chart[21]
9

UK Singles Chart
90

US Billboard Hot Modern Rock Tracks
11

US Billboard Hot Mainstream Rock Tracks
33

US Billboard Hot Adult Top 40 Tracks
23

US Billboard Hot 100
94

US Billboard Pop 100
69

Chart (2009)
Peak
position

Swedish Singles Chart
42

Chart (2017)
Peak
position

Czech Republic (Singles Digitál Top 100)[22]
80

US Hot Rock Songs (Billboard)[23]
22

text: Year-end charts[edit]

text:
Chart (2008)
Position

German Singles Chart[24]
93

text: Certifications[edit]

text:
Region
Certification
Certified units/Sales

United States (RIAA)[25]
Platinum
1,000,000


document_title: Ke-mo sah-bee

question_text: in the lone ranger what does kemosabe mean

text: Ke-mo sah-bee

text: Spelling[edit]

text: Fran Striker, writer of the original Lone Ranger radio program, spelled the word "ke-mo sah-bee".

text: Meaning and origin[edit]

text: There are many theories about the origin and meaning of this word. A common story[3] is that it derives from a Spanish phrase such as "¿Quién sabe?" or "quien no sabe", meaning "Who knows?" or "he who does not know". This is implausible because Jim Jewell, director of The Lone Ranger from 1933 to 1939, took the phrase from Kamp Kee-Mo Sah-Bee, a boys' camp on Mullett Lake in Michigan, established by Charles W. Yeager (Jewell's father-in-law) in 1916.[4] Yeager himself probably took the term from Ernest Thompson Seton, one of the founders of the Boy Scouts of America, who had given the meaning "scout runner" to Kee-mo-sah'-bee in his 1912 book "The Book of Woodcraft and Indian Lore".[5]

text: Kamp Kee-Mo Sah-Bee was in an area inhabited by the Ottawa, who speak a language which is mutually comprehensible with Ojibwe. John D. Nichols and Earl Nyholm's A Concise Dictionary of Minnesota Ojibwe defines the Ojibwe word giimoozaabi as "he peeks" (and, in theory, "he who peeks"), making use of the prefix giimoo(j)-, "secretly"; Rob Malouf, now an associate professor of linguistics at San Diego State University, suggested that "giimoozaabi" may indeed have also meant scout (i.e., "one who sneaks").[6]

text: There have been jokes about the name "kemo sabe". A Far Side cartoon had the then long-retired Lone Ranger discover that the name meant the rear end of a horse. Homer and Jethro's parody of the Stonewall Jackson song "Waterloo" had the following verse: "The Lone Ranger and Tonto rode the trail / catching outlaws and putting them in jail/ But the Ranger shot old Tonto 'cause it seems / he found out what Kemo Sabe means/ (Waterloo refrain follows) The Lone Ranger he did trust / That old Tonto bit the dust."

text: Use in the television series[edit]

text: In the old Lone Ranger TV series, the Ranger's faithful friend and partner Tonto, played by First Nations actor Jay Silverheels for the entire run of the series, was asked in many scenes what "Kemosabe" meant. His reply was invariably, "It mean Trusty Scout!" The made-for-TV movie Enter the Lone Ranger (1949) combined the plots of the first three episodes of the Lone Ranger TV series: "Enter the Lone Ranger", "The Lone Ranger Fights On", and "The Lone Ranger Triumphs" into a complete story related to the origins of the Lone Ranger and his fight for justice for all regardless of sex, race, or creed.

text: In both, Tonto finds the forever nameless younger brother of a famous Texas Ranger "Capt. Reid" barely alive. A medallion around the young man's neck helps identify him as the same boy who'd saved Tonto after a renegade attack had wiped out his own family some years earlier. Tonto declares the young man, played by Clayton Moore, worthy of brotherhood and, after a "traditional" blood-sharing ceremony gives him the name "Kemosabe" or "Trusty Scout".

text: Other uses[edit]

text:
Khemosabi was the name of a champion Arabian horse. His owners popularized his show career with a series of Lone Ranger themed cartoons.
Kimosabe is a 1999 album by Kim Mitchell.
Kemosabe Records, American record label owned by Sony
"Kemosabe" is a 2013 song by the British indie pop band Everything Everything.
Kemo Sabe is a fictional type of cruise missile in Matt Ruff's book Sewer, Gas & Electric: The Public Works Trilogy. One is used to kill President Assad in the War of Syrian Containment (in the book).
Larry Pennell plays the character Kemosabe in the 2002 movie Bubba Ho-Tep.

tag: ul


document_title: List of Himalayan peaks and passes

question_text: what is the highest peak of the himalayas

text: List of Himalayan peaks and passes

text: Overall, the Himalayan mountain system is the world's highest, and is home to 10 of 14 of the world's highest peaks, the Eight-thousanders, and a further 50 peaks over There over 50 Himalayan peaks with elevation over 7,000 metres (23,000 ft). The Karakoram and Hindu Kush are regarded as separate ranges. The rugged terrain makes few routes through the mountains possible.

text: Peaks[edit]

text:
[show]Map all coordinates using OSM
Map all coordinates using Google

Export all coordinates as KML

Export all coordinates as GPX

Map all microformatted coordinates

Place data as RDF

text:
Global Rank
Peak Name
Other names and meaning
Elevation
Prominence
Isolation
Region
Coordinates
Country
First Ascent
Notes

m
ft

1
Mount Everest
Sagarmatha, Chomolungma
8,848
29,029
8,848
infinite
Mahalangur

27°59′17″N 86°55′31″E / 27.98806°N 86.92528°E / 27.98806; 86.92528 (1. Mount Everest / Sagarmatha / Chomolungma (8848 m))

Nepal • China
1953
HP World

3
Kanchenjunga
"Five treasures of great snow"
8,586
28,169
3,922
124.3
E Nepal/Sikkim
27°42′12″N 88°08′51″E / 27.70333°N 88.14750°E / 27.70333; 88.14750 (3. Kangchenjunga (8586 m))
Nepal • India
1955
Easternmost 8000m peak, HP India

4
Lhotse
"South Peak"
8,516
27,940
610
2.7
Mahalangur
27°57′42″N 86°55′59″E / 27.96167°N 86.93306°E / 27.96167; 86.93306 (4. Lhotse (8516 m))
Nepal • China
1956
Part of Everest massif.

5
Makalu
"The Great Black"
8,485
27,838
2,378
17.2
Mahalangur
27°53′23″N 87°05′20″E / 27.88972°N 87.08889°E / 27.88972; 87.08889 (5. Makalu (8485 m))
Nepal • China
1955
east of Mt. Everest

6
Cho Oyu
"Turquoise Goddess"
8,188
26,864
2,340
28.5
Mahalangur
28°05′39″N 86°39′39″E / 28.09417°N 86.66083°E / 28.09417; 86.66083 (6. Cho Oyu (8188 m))
Nepal • China
1954
Easiest 8000m peak

7
Dhaulagiri I
"White Mountain"
8,167
26,795
3,357
317.6
Central
28°41′48″N 83°29′35″E / 28.69667°N 83.49306°E / 28.69667; 83.49306 (7. Dhaulagiri I (8167 m))
Nepal
1960
west of Gandaki River

8
Manaslu
Kutang, "Mountain of the Spirit"
8,163
26,781
3,092
105.6
Central
28°33′00″N 84°33′35″E / 28.55000°N 84.55972°E / 28.55000; 84.55972 (8. Manaslu (8163 m))
Nepal
1956

9
Nanga Parbat
Diamir, "Naked Mountain"
8,126
26,660
4,608
188.5
Gilgit-Baltistan (GB) region
35°14′14″N 74°35′21″E / 35.23722°N 74.58917°E / 35.23722; 74.58917 (9. Nanga Parbat (8126 m))
Pakistan
1953
Westernmost peak of Himalayas, rises 7000m above Indus River.

10
Annapurna I
"Goddess of the Harvests"
8,091
26,545
2,984
33.9
Central
28°35′44″N 83°49′13″E / 28.59556°N 83.82028°E / 28.59556; 83.82028 (10. Annapurna I (8091 m))
Nepal
1950
north of Pokhara

14
Shishapangma
"Crest above the grassy plains", Gosainthan
8,027
26,335
2,897
91.3
Central
28°21′12″N 85°46′43″E / 28.35333°N 85.77861°E / 28.35333; 85.77861 (14. Shishapangma (8027 m))
China
1964
about 10 km north of Nepal border.

15
Gyachung Kang
unknown
7,952
26,089
672
7.6
Mahalangur
28°05′53″N 86°44′32″E / 28.09806°N 86.74222°E / 28.09806; 86.74222 (15. Gyachung Kang (7952 m))
Nepal • China
1964
Highest mountain under 8,000m

Nuptse
"West Peak" in Tibetan
7,861
25,791
305
3.4
Mahalangur

Nepal
1961
sub peak of Lhotse

23
Nanda Devi
"Bliss-giving Goddess"
7,816
25,643
3,139
388.7
Garhwal
30°22′33″N 79°58′15″E / 30.37583°N 79.97083°E / 30.37583; 79.97083 (23. Nanda Devi (7816 m))
India
1936
HP Uttarakhand. Highest peak entirely within India.

28
Namcha Barwa

7,782
25,531
4,106
707.8
Assam
29°37′52″N 95°03′19″E / 29.63111°N 95.05528°E / 29.63111; 95.05528 (28. Namcha Barwa (7782 m))
China
1992
Eastern end of Himalaya

29
Kamet

7,756
25,446
2,825
70.3
Garhwal
30°55′12″N 79°35′30″E / 30.92000°N 79.59167°E / 30.92000; 79.59167 (29. Kamet (7756 m))
India
1931

34
Gurla Mandhata

7,694
25,243
2,788
127.5
West Tibetan
30°26′19″N 81°17′48″E / 30.43861°N 81.29667°E / 30.43861; 81.29667 (34. Gurla Mandhata (7694 m))
China
1985

40
Gangkhar Puensum
Gankar Punzum, "Three Mountain Siblings"
7,570
24,836
2,995
228.1
Bhutanese
28°02′50″N 90°27′19″E / 28.04722°N 90.45528°E / 28.04722; 90.45528 (40. Gangkhar Puensum (7570 m))
Bhutan • China
unclimbed
HP Bhutan. World's highest unclimbed peak. Off-limits.

45
Kula Kangri

7,538
24,731
1,654
25.4
Bhutanese
28°13′37″N 90°36′59″E / 28.22694°N 90.61639°E / 28.22694; 90.61639 (45. Kula Kangri (7538 m))
China (Bhutan)[1]
1986

62
Yangra
Ganesh I
7,422
24,350
2,352
48.1
Central
28°23′29″N 85°07′38″E / 28.39139°N 85.12722°E / 28.39139; 85.12722 (62. Yangra / Ganesh I (7422 m))
Nepal • China
1955

75
Labuche Kang

7,367
24,170
1,957
38.3
Central
28°18′15″N 86°21′03″E / 28.30417°N 86.35083°E / 28.30417; 86.35083 (75. Labuche Kang (7367 m))
China
1987

78
Jomolhari

7,326
24,035
2,065
106
Bhutanese
27°49′36″N 89°16′04″E / 27.82667°N 89.26778°E / 27.82667; 89.26778 (78. Jomolhari (7326 m))
Bhutan • China
1937

84
Gyala Peri

7,294
23,930
2,942
20.4
Assam[2]
29°48′52″N 94°58′07″E / 29.81444°N 94.96861°E / 29.81444; 94.96861 (84. Gyala Peri (7294 m))
China
1986

98
Langtang Lirung

7,227
23,711
1,534
24.5
Central
28°15′22″N 85°31′01″E / 28.25611°N 85.51694°E / 28.25611; 85.51694 (98. Langtang Lirung (7227 m))
Nepal
1978

102
Tongshanjiabu

7,207
23,645
1,757
38.8
Bhutanese
28°11′12″N 89°57′27″E / 28.18667°N 89.95750°E / 28.18667; 89.95750 (102. Tongshanjiabu (7207 m))
Bhutan • China[3]
unclimbed

104
Noijin Kangsang

7,206
23,642
2,160
88.4
East Tibetan
28°56′48″N 90°10′42″E / 28.94667°N 90.17833°E / 28.94667; 90.17833 (104. Noijin Kangsang / Norin Kang (7206 m))
China
1986

120
Nun

7,135
23,409
2,404
166.7
Punjab
33°58′48″N 76°01′18″E / 33.98000°N 76.02167°E / 33.98000; 76.02167 (Nun)
India
1953

148
Kangto

7,060
23,163
2,195
189.6
Assam
27°51′54″N 92°31′57″E / 27.86500°N 92.53250°E / 27.86500; 92.53250 (Kangto)
India • China

Machapuchare
"Fish Tail"
6,993
22,943
1233
9.2
Central
28°29′42″N 83°56′57″E / 28.49500°N 83.94917°E / 28.49500; 83.94917 (Machapuchare)
Nepal
1957 (short of summit.)
Sacred to Shiva, off-limits.

Dorje Lakpa
"Langtang Himal"
6,966
22,854
796
15.1
Central
28°10′26″N 85°46′45″E / 28.17389°N 85.77917°E / 28.17389; 85.77917 (Dorje Lakpa)
Nepal
1992
NW of Kathmandu.

Ama Dablam
"Mother And Her Necklace"
6,814
22,356
1027
10.3
Mahalangur
27°51′40″N 86°51′40″E / 27.86111°N 86.86111°E / 27.86111; 86.86111 (Ama Dablam (6814m))
Nepal
1961

Mount Kailash
Kang Rinpoche (Precious Snow Peak)
6,638
21,778
1319
66.0
West Tibetan[4]
31°4′0″N 81°18′45″E / 31.06667°N 81.31250°E / 31.06667; 81.31250 (Mount Kailash)
China
Unclimbed
Sacred to four religions, near sources of four major rivers.

text: Passes and routes[edit]

text: Some routes through the Himalaya include:

text:
Notable passes and routes

Pass or route
Elevation
Coordinates
Notes

m
ft

Banihal Pass
2,832
9,291
33°31′N 75°16′E / 33.517°N 75.267°E / 33.517; 75.267 (Banihal Pass)
connecting the hill areas of Jammu to the Kashmir Valley

Zoji La
3,528
11,575
34°16′44″N 75°28′19″E / 34.27889°N 75.47194°E / 34.27889; 75.47194 (Zoji La)
between the vale of Kashmir and the Kargil district, and is the only Western entrance to the highlands of Ladakh

Rohtang Pass
3,973
13,035
32°22′17″N 77°14′47″E / 32.37139°N 77.24639°E / 32.37139; 77.24639 (Rohtang Pass)
Himachal Pradesh, India.

Mohan Pass
800
2,600
30°14′N 77°58′E / 30.233°N 77.967°E / 30.233; 77.967 (Mohan Pass)
the principal pass in the Siwalik Hills, the southernmost and geologically youngest foothills running parallel to the main Himalayas in Sikkim.

Kora La
4,594
15,072
29°18′14″N 83°58′7″E / 29.30389°N 83.96861°E / 29.30389; 83.96861 (Kora La)
on the Nepal-Tibet border at the upper end of Mustang. The Kali Gandaki Gorge (a graben),[5] transects the main Himalaya and Transhimalayan ranges. Kora La is the lowest pass through both ranges between K2 and Everest, but some 300 metres (980 ft) higher than Nathula and Jelepla passes further east between Sikkim and Tibet

Arniko Rajmarg/Friendship Highway route
5,260
17,260

from Kathmandu, Nepal crossing into Tibet at Kodari/Zhangmu, to Nyalam, Lalung-La pass (5,050m/16,570'), Tingri, Shelkar, Gyatso La pass, to Lhatse on the Yarlung Tsangpo/Brahmaputra River about 460 road kilometers west of Lhasa

Gangtok
4,310
14,140
27°20′N 88°37′E / 27.33°N 88.62°E / 27.33; 88.62 (Gangtok)
in Sikkim to Lhasa in Tibet, via the Nathula and Jelepla Passes (offshoots of the ancient Silk Road)

Thorong La
5,416
17,769
28°47′37″N 83°56′14″E / 28.79361°N 83.93722°E / 28.79361; 83.93722 (Thorong La)
The high point of the Annapurna Circuit, it connects the Manang District to the Mustang District in Nepal.

Mana Pass
5,545
18,192
31°04′06″N 79°25′00″E / 31.06833°N 79.41667°E / 31.06833; 79.41667 (Mana Pass)
on the border between India and Tibet

Seela Pass
4,177
13,704

on the Road between Bomdila town and Tawang Town in Arunachala pradesh state in INDIA


document_title: Dissociative identity disorder

question_text: when was dissociative identity disorder added to the dsm

question_tokens: when was dissociative identity disorder added to the dsm

text: Dissociative identity disorder

text: Definitions[edit]

text: Dissociation, the term that underlies the dissociative disorders including DID, lacks a precise, empirical, and generally agreed upon definition.[7][17][18] A large number of diverse experiences have been termed dissociative, ranging from normal failures in attention to the breakdowns in memory processes characterized by the dissociative disorders. Thus it is unknown if there is a common root underlying all dissociative experiences, or if the range of mild to severe symptoms is a result of different etiologies and biological structures.[7] Other terms used in the literature, including personality, personality state, identity, ego state and amnesia, also have no agreed upon definitions.[15][17] Multiple competing models exist that incorporate some non-dissociative symptoms while excluding dissociative ones.[17] The most widely used model of dissociation conceptualizes DID as at one extreme of a continuum of dissociation, with flow at the other end, though this model is being challenged.[18]

text: Some terms have been proposed regarding dissociation. Psychiatrist Paulette Gillig draws a distinction between an "ego state" (behaviors and experiences possessing permeable boundaries with other such states but united by a common sense of self) and the term "alters" (each of which may have a separate autobiographical memory, independent initiative and a sense of ownership over individual behavior) commonly used in discussions of DID.[19] Ellert Nijenhuis and colleagues suggest a distinction between personalities responsible for day-to-day functioning (associated with blunted physiological responses and reduced emotional reactivity, referred to as the "apparently normal part of the personality" or ANP) and those emerging in survival situations (involving fight-or-flight responses, vivid traumatic memories and strong, painful emotions, the "emotional part of the personality" or EP).[20] "Structural dissociation of the personality" is used by Otto van der Hart and colleagues to distinguish dissociation they attribute to traumatic or pathological causes, which in turn is divided into primary, secondary and tertiary dissociation. According to this hypothesis, primary dissociation involves one ANP and one EP, while secondary dissociation involves one ANP and at least two EPs and tertiary dissociation, which is unique to DID, is described as having at least two ANP and at least two EP.[7] Others have suggested dissociation can be separated into two distinct forms, detachment and compartmentalization, the latter of which, involving a failure to control normally controllable processes or actions, is most evident in DID. Efforts to psychometrically distinguish between normal and pathological dissociation have been made, but they have not been universally accepted.[7]

text: Signs and symptoms[edit]

text: According to the fifth Diagnostic and Statistical Manual of Mental Disorders (DSM-5), DID symptoms include "the presence of two or more distinct personality states" accompanied by the inability to recall personal information, beyond what is expected through normal forgetfulness. Other DSM-5 symptoms include a loss of identity as related to individual distinct personality states, and loss referring to time, sense of self and consciousness.[2] In each individual, the clinical presentation varies and the level of functioning can change from severely impaired to adequate.[16][21] The symptoms of dissociative amnesia are subsumed under the DID diagnosis but can be diagnosed separately. Individuals with DID may experience distress from both the symptoms of DID (intrusive thoughts or emotions) and the consequences of the accompanying symptoms (dissociation rendering them unable to remember specific information).[22] The majority of patients with DID report childhood sexual or physical abuse, though the accuracy of these reports is controversial.[3] Identities may be unaware of each other and compartmentalize knowledge and memories, resulting in chaotic personal lives.[21] Individuals with DID may be reluctant to discuss symptoms due to associations with abuse, shame, and fear.[3] DID patients may also frequently and intensely experience time disturbances.[23]

text: Around half of people with DID have less than 10 identities and most have less than 100; as many as 4,500 have been reported.[7]:503 The average number of identities has increased over the past few decades, from two or three to now an average of approximately 16. However, it is unclear whether this is due to an actual increase in identities, or simply that the psychiatric community has become more accepting of a high number of compartmentalized memory components.[7] The primary identity, which often has the patient's given name, tends to be "passive, dependent, guilty and depressed" with other personalities being more active, aggressive or hostile, and often containing a current time line that lacks childhood memory. Most identities are of ordinary people, though fictional, mythical, celebrity and animal parts have been reported.[7]:503

text: Comorbid disorders[edit]

text: The psychiatric history frequently contains multiple previous diagnoses of various disorders and treatment failures.[24] The most common presenting complaint of DID is depression, with headaches being a common neurological symptom. Comorbid disorders can include substance abuse, eating disorders, anxiety, posttraumatic stress disorder (PTSD), and personality disorders.[25] A significant percentage of those diagnosed with DID have histories of borderline personality disorder and bipolar disorder.[26] Further, data supports a high level of psychotic symptoms in individuals with DID, and that both individuals diagnosed with schizophrenia and those diagnosed with DID have histories of trauma.[27] Other disorders that have been found to be comorbid with DID are somatization disorders, major depressive disorder, as well as history of a past suicide attempt, in comparison to those without a DID diagnosis.[28] Individuals diagnosed with DID demonstrate the highest hypnotizability of any clinical population.[22] The large number of symptoms presented by individuals diagnosed with DID has led some clinicians to suggest that, rather than being a separate disorder, diagnosis of DID is actually an indication of the severity of the other disorders diagnosed in the patient.[7]

text: Borderline personality disorder[edit]

text: The DSM-IV-TR states that acts of self-mutilation, impulsivity, and rapid changes in interpersonal relationships "may warrant a concurrent diagnosis of borderline personality disorder".[2] Steven Lynn and colleagues have suggested that the significant overlap between BPD and DID may be a contributing factor to the development of therapy induced DID, in that the suggestion of hidden alters by therapists who propose a diagnosis of DID provides an explanation to patients for the behavioral instability, self-mutilation, unpredictable mood changes and actions they experience.[8] In 1993 a group of researchers reviewed both DID and borderline personality disorder (BPD), concluding that DID was an epiphenomenon of BPD, with no tests or clinical description capable of distinguishing between the two. Their conclusions about the empirical proof of DID were echoed by a second group, who still believed the diagnosis existed, but while the knowledge to date did not justify DID as a separate diagnosis, it also did not disprove its existence.[19] Reviews of medical records and psychological tests indicated that the majority of DID patients could be diagnosed with BPD instead, though about a third could not, suggesting that DID does exist but may be over-diagnosed.[19] Between 50 and 66% of patients also meet the criteria for BPD, and nearly 75% of patients with BPD also meet the criteria for DID, with considerable overlap between the two conditions in terms of personality traits, cognitive and day-to-day functioning, and ratings by clinicians. Both groups also report higher rates of physical and sexual abuse than the general population, and patients with BPD also score highly on measures of dissociation.[7] Even using strict diagnostic criteria, it can be difficult to distinguish between dissociative disorders and BPD (as well as bipolar disorder and schizophrenia),[17] though the presence of comorbid anxiety disorders may help.[29]

text: Causes[edit]

text: The cause of DID is unknown and widely debated, with debate occurring between supporters of different hypotheses: that DID is a reaction to trauma; that DID is produced by inappropriate psychotherapeutic techniques that cause a patient to enact the role of a patient with DID; and newer hypotheses involving memory processing that allows for the possibility that trauma-causing dissociation can occur after childhood in DID, as it does in PTSD. It has been suggested that all the trauma-based and stress-related disorders be placed in one category that would include both DID and PTSD.[30] Disturbed and altered sleep has also been suggested as having a role in dissociative disorders in general and specifically in DID, alterations in environments also largely affecting the DID patient.[31]

text: Research is needed to determine the prevalence of the disorder in those who have never been in therapy, and the prevalence rates across cultures. These central issues relating to the epidemiology of DID remain largely unaddressed despite several decades of research.[32] The debates over the causes of DID also extend to disagreements over how the disorder is assessed and treated.[7]

text: Developmental trauma[edit]

text: People diagnosed with DID often report that they have experienced severe physical and sexual abuse, especially during early to mid-childhood[33] (although the accuracy of these reports has been disputed[2]), and others report an early loss, serious medical illness or other traumatic event.[21] They also report more historical psychological trauma than those diagnosed with any other mental illness.[34] Severe sexual, physical, or psychological trauma in childhood has been proposed as an explanation for its development; awareness, memories and emotions of harmful actions or events caused by the trauma are removed from consciousness, and alternate personalities or subpersonalities form with differing memories, emotions and behavior.[35] DID is attributed to extremes of stress or disorders of attachment. What may be expressed as post-traumatic stress disorder in adults may become DID when occurring in children, possibly due to their greater use of imagination as a form of coping.[19][22] Possibly due to developmental changes and a more coherent sense of self past the age of six, the experience of extreme trauma may result in different, though also complex, dissociative symptoms and identity disturbances.[22] A specific relationship between childhood abuse, disorganized attachment, and lack of social support are thought to be a necessary component of DID.[19] Other suggested explanations include insufficient childhood nurturing combined with the innate ability of children in general to dissociate memories or experiences from consciousness.[21]

text: Delinking early trauma from the etiology of dissociation has been explicitly rejected by those supporting the early trauma model. However, a 2012 review article supports the hypothesis that current or recent trauma may affect an individual's assessment of the more distant past, changing the experience of the past and resulting in dissociative states.[36] Giesbrecht et al. have suggested there is no actual empirical evidence linking early trauma to dissociation, and instead suggest that problems with neuropsychological functioning, such as increased distractibility in response to certain emotions and contexts, account for dissociative features.[37] A middle position hypothesizes that trauma, in some situations, alters neuronal mechanisms related to memory. Evidence is increasing that dissociative disorders are related both to a trauma history and to "specific neural mechanisms".[22] It has also been suggested that there may be a genuine but more modest link between trauma and DID, with early trauma causing increased fantasy-proneness, which may in turn render individuals more vulnerable to socio-cognitive influences surrounding the development of DID.[8] Another suggestion made by Hart indicates that there are triggers in the brain that can be the catalyst for different self-states, and that victims of trauma are more susceptible to these triggers than non-victims of trauma; These triggers are said to be related to DID.[38]

text: The suggestion that DID was the result of childhood trauma increased the appeal of the diagnosis among health care providers, patients and the public as it validated the idea that child abuse had lifelong, serious effects. There is very little experimental evidence supporting the trauma-dissociation hypothesis, and no research showing that dissociation consistently links to long-term memory disruption.[39]

text: Therapist-induced[edit]

text: The prevailing post-traumatic model of dissociation and dissociative disorders is contested.[8] It has been hypothesized that symptoms of DID may be created by therapists using techniques to "recover" memories (such as the use of hypnosis to "access" alter identities, facilitate age regression or retrieve memories) on suggestible individuals.[6][15][16][32][40] Referred to as the "sociocognitive model" (SCM), it proposes that DID is due to a person consciously or unconsciously behaving in certain ways promoted by cultural stereotypes,[32] with unwitting therapists providing cues through improper therapeutic techniques. This behavior is enhanced by media portrayals of DID.[8]

text: Proponents of the SCM note that the bizarre dissociative symptoms are rarely present before intensive therapy by specialists in the treatment of DID who, through the process of eliciting, conversing with and identifying alters, shape, or possibly create the diagnosis. While proponents note that DID is accompanied by genuine suffering and the distressing symptoms, and can be diagnosed reliably using the DSM criteria, they are skeptical of the traumatic etiology suggested by proponents.[41] The characteristics of people diagnosed with DID (hypnotizability, suggestibility, frequent fantasization and mental absorption) contributed to these concerns and those regarding the validity of recovered memories of trauma.[42] Skeptics note that a small subset of doctors are responsible for diagnosing the majority of individuals with DID.[6][15][39] Psychologist Nicholas Spanos and others have suggested that in addition to therapy caused cases, DID may be the result of role-playing rather than alternative identities, though others disagree, pointing to a lack of incentive to manufacture or maintain separate identities and point to the claimed histories of abuse.[43] Other arguments that therapy can cause DID, include the lack of children diagnosed with DID, the sudden spike in rates of diagnosis after 1980 (although DID was not a diagnosis until DSM-IV, published in 1994), the absence of evidence of increased rates of child abuse, the appearance of the disorder almost exclusively in individuals undergoing psychotherapy, particularly involving hypnosis, the presences of bizarre alternate identities (such as those claiming to be animals or mythological creatures) and an increase in the number of alternate identities over time[8][15] (as well as an initial increase in their number as psychotherapy begins in DID-oriented therapy.[8]) These various cultural and therapeutic causes occur within a context of pre-existing psychopathology, notably borderline personality disorder, which is commonly comorbid with DID.[8] In addition, presentations can vary across cultures, such as Indian patients who only switch alters after a period of sleep — which is commonly how DID is presented by the media within that country.[8]

text: The therapy-caused cases of DID, it is argued, are strongly linked to false memory syndrome, a concept and term coined by members of the False Memory Syndrome Foundation in reaction to memories of abuse they allege were recovered by a range of controversial therapies whose effectiveness is unproven. Such a memory could be used to make a false allegation of child sexual abuse. There is little agreement between those who see therapy as a cause and trauma as a cause.[5] Supporters of therapy as a cause of DID suggest that a small number of clinicians diagnosing a disproportionate number of cases would provide evidence for their position[32] though it has also been claimed that higher rates of diagnosis in specific countries like the United States, may be due to greater awareness of DID. Lower rates in other countries may be due to an artificially low recognition of the diagnosis.[16] However, false memory syndrome per se is not regarded by mental health experts as a valid diagnosis,[44] and has been described as "a non-psychological term originated by a private foundation whose stated purpose is to support accused parents",[45] and critics argue that the concept has no empirical support, and furthermore describe the False Memory Syndrome Foundation as an advocacy group that has distorted and misrepresented research into memory.[46][47]

text: Children[edit]

text: DID is rarely diagnosed in children, despite the average age of appearance of the first alter being three years.[15] This fact is cited as a reason to doubt the validity of DID,[15][32] and proponents of both etiologies believe that the discovery of DID in a child that had never undergone treatment would critically undermine the SCM. Conversely, if children are found to only develop DID after undergoing treatment it would challenge the traumagenic model.[32] As of 2011[update], approximately 250 cases of DID in children have been identified, though the data does not offer unequivocal support for either theory. While children have been diagnosed with DID before therapy, several were presented to clinicians by parents who were themselves diagnosed with DID; others were influenced by the appearance of DID in popular culture or due to a diagnosis of psychosis due to hearing voices—a symptom also found in DID. No studies have looked for children with DID in the general population, and the single study that attempted to look for children with DID not already in therapy did so by examining siblings of those already in therapy for DID. An analysis of diagnosis of children reported in scientific publications, 44 case studies of single patients were found to be evenly distributed (i.e., each case study was reported by a different author) but in articles regarding groups of patients, four researchers were responsible for the majority of the reports.[32]

text: The initial theoretical description of DID was that dissociative symptoms were a means of coping with extreme stress (particularly childhood sexual and physical abuse), but this belief has been challenged by the data of multiple research studies.[8] Proponents of the traumagenic hypothesis claim the high correlation of child sexual and physical abuse reported by adults with DID corroborates the link between trauma and DID.[7][8] However, the DID-maltreatment link has been questioned for several reasons. The studies reporting the links often rely on self-report rather than independent corroborations, and these results may be worsened by selection and referral bias.[7][8] Most studies of trauma and dissociation are cross-sectional rather than longitudinal, which means researchers can not attribute causation, and studies avoiding recall bias have failed to corroborate such a causal link.[7][8] In addition, studies rarely control for the many disorders comorbid with DID, or family maladjustment (which is itself highly correlated with DID).[7][8] The popular association of DID with childhood abuse is relatively recent, occurring only after the publication of Sybil in 1973. Most previous examples of "multiples" such as Chris Costner Sizemore, whose life was depicted in the book and film The Three Faces of Eve, disclosed no history of child abuse.[41]

text: Diagnosis[edit]

text: The fourth, revised edition of the American Psychiatric Association's Diagnostic and Statistical Manual of Mental Disorders (DSM-IV-TR) diagnoses DID according to the diagnostic criteria found in section 300.14 (dissociative disorders). It has also been found difficult to diagnose the disorder in the first place, due to there not being a universal agreement of the definition of dissociation.[48] The criteria require that an adult be recurrently controlled by two or more discrete identities or personality states, accompanied by memory lapses for important information that is not caused by alcohol, drugs or medications and other medical conditions such as complex partial seizures.[2] While otherwise similar, the diagnostic criteria for children also specifies symptoms must not be confused with imaginative play.[7] Diagnosis is normally performed by a clinically trained mental health professional such as a psychiatrist or psychologist through clinical evaluation, interviews with family and friends, and consideration of other ancillary material. Specially designed interviews (such as the SCID-D) and personality assessment tools may be used in the evaluation as well.[24] Since most of the symptoms depend on self-report and are not concrete and observable, there is a degree of subjectivity in making the diagnosis.[17] People are often disinclined to seek treatment, especially since their symptoms may not be taken seriously; thus dissociative disorders have been referred to as "diseases of hiddenness".[42][49]

text: The diagnosis has been criticized by supporters of therapy as a cause or the sociocognitive hypothesis as they believe it is a culture-bound and often health care induced condition.[7][15][40] The social cues involved in diagnosis may be instrumental in shaping patient behavior or attribution, such that symptoms within one context may be linked to DID, while in another time or place the diagnosis could have been something other than DID.[39] Other researchers disagree and argue that the existence of the condition and its inclusion in the DSM is supported by multiple lines of reliable evidence, with diagnostic criteria allowing it to be clearly discriminated from conditions it is often mistaken for (schizophrenia, borderline personality disorder, and seizure disorder).[16] That a large proportion of cases are diagnosed by specific health care providers, and that symptoms have been created in nonclinical research subjects given appropriate cueing has been suggested as evidence that a small number of clinicians who specialize in DID are responsible for the creation of alters through therapy.[7]

text: Screening[edit]

text: Perhaps due to their perceived rarity, the dissociative disorders (including DID) were not initially included in the Structured Clinical Interview for DSM-IV (SCID), which is designed to make psychiatric diagnoses more rigorous and reliable.[17] Instead, shortly after the publication of the initial SCID a freestanding protocol for dissociative disorders (SCID-D)[50] was published.[17] This interview takes about 30 to 90 minutes depending on the subject's experiences.[51] An alternative diagnostic instrument, the Dissociative Disorders Interview Schedule, also exists but the SCID-D is generally considered superior.[17] The Dissociative Disorders Interview Schedule (DDIS) is a highly structured interview that discriminates among various DSM-IV diagnoses. The DDIS can usually be administered in 30–45 minutes.[52]

text: Other questionnaires include the Dissociative Experiences Scale (DES), Perceptual Alterations Scale, Questionnaire on Experiences of Dissociation, Dissociation Questionnaire, and the Mini-SCIDD. All are strongly intercorrelated and except the Mini-SCIDD, all incorporate absorption, a normal part of personality involving narrowing or broadening of attention.[17] The DES[53] is a simple, quick, and validated[54] questionnaire that has been widely used to screen for dissociative symptoms, with variations for children and adolescents. Tests such as the DES provide a quick method of screening subjects so that the more time-consuming structured clinical interview can be used in the group with high DES scores. Depending on where the cutoff is set, people who would subsequently be diagnosed can be missed. An early recommended cutoff was 15-20.[55] The reliability of the DES in non-clinical samples has been questioned.[56]

text: Differential diagnoses[edit]

text: People with DID are diagnosed with five to seven comorbid disorders on average—much higher than other mental illnesses.[19] Due to overlapping symptoms, differential diagnosis includes schizophrenia, normal and rapid-cycling bipolar disorder, epilepsy, borderline personality disorder, and Asperger syndrome.[57] Delusions or auditory hallucinations can be mistaken for speech by other personalities.[22] Persistence and consistency of identities and behavior, amnesia, measures of dissociation or hypnotizability and reports from family members or other associates indicating a history of such changes can help distinguish DID from other conditions. A diagnosis of DID takes precedence over any other dissociative disorders. Distinguishing DID from malingering is a concern when financial or legal gains are an issue, and factitious disorder may also be considered if the person has a history of help or attention seeking. Individuals who state that their symptoms are due to external spirits or entities entering their bodies are generally diagnosed with dissociative disorder not otherwise specified rather than DID due to the lack of identities or personality states.[2] Most individuals who enter an emergency department and are unaware of their names are generally in a psychotic state. Although auditory hallucinations are common in DID, complex visual hallucinations may also occur.[19] Those with DID generally have adequate reality testing; they may have positive Schneiderian symptoms of schizophrenia but lack the negative symptoms.[58] They perceive any voices heard as coming from inside their heads (patients with schizophrenia experience them as external).[7] In addition, individuals with psychosis are much less susceptible to hypnosis than those with DID.[22] Difficulties in differential diagnosis are increased in children.[32]

text: DID must be distinguished from, or determined if comorbid with, a variety of disorders including mood disorders, psychosis, anxiety disorders, posttraumatic stress disorder, personality disorders, cognitive disorders, neurological disorders, epilepsy, somatoform disorder, factitious disorder, malingering, other dissociative disorders, and trance states.[9] An additional aspect of the controversy of diagnosis is that there are many forms of dissociation and memory lapses, which can be common in both stressful and nonstressful situations and can be attributed to much less controversial diagnoses.[39] Individuals faking or mimicking DID due to factitious disorder will typically exaggerate symptoms (particularly when observed), lie, blame bad behavior on symptoms and often show little distress regarding their apparent diagnosis. In contrast, genuine DID patients typically exhibit confusion, distress and shame regarding their symptoms and history.[9] The condition may be under-diagnosed due to skepticism and lack of awareness from mental health professionals, made difficult due to the lack of specific and reliable criteria for diagnosing DID as well as a lack of prevalence rates due to the failure to examine systematically selected and representative populations.[6][59] A specific relationship between DID and borderline personality disorder has been posited several times, with various clinicians noting significant overlap between symptoms and patient behaviors and it has been suggested that some cases of DID may arise "from a substrate of borderline traits". Reviews of DID patients and their medical records concluded that the majority of those diagnosed with DID would also meet the criteria for either borderline personality disorder or more generally borderline personality.[19]

text: Issues affecting diagnosis[edit]

text: The DSM-5 elaborates on cultural background as an influence for some clinical presentations of DID.[60]

text: Many features of dissociative identity disorder can be influenced by the individual's cultural background. Individuals with this disorder may present with prominent medically unexplained neurological symptoms, such as non-epileptic seizures, paralyses, or sensory loss, in cultural settings where such symptoms are common. Similarly, in settings where normative possession is common (e.g., rural areas in the developing world, among certain religious groups in the United States and Europe), the fragmented identities may take the form of possessing spirits, deities, demons, animals, or mythical figures. Acculturation or prolonged intercultural contact may shape the characteristics of other identities(e.g., identities in India may speak English exclusively and wear Western clothes). Possession-form dissociative identity disorder can be distinguished from culturally accepted possession states in that the former is involuntary, distressing, uncontrollable, and often recurrent or persistent; involves conflict between the individual and his or her surrounding family, social, or work milieu; and is manifested at times and in places that violate the norms of the culture or religion.

text: History of the DSM diagnosis[edit]

text: The DSM-II used the term Hysterical Neurosis, Dissociative Type. It described the possible occurrence of alterations in the patient's state of consciousness or identity, and included the symptoms of "amnesia, somnambulism, fugue, and multiple personality".[61] The DSM-III grouped the diagnosis with the other four major dissociative disorders using the term "multiple personality disorder". The DSM-IV made more changes to DID than any other dissociative disorder,[16] and renamed it DID.[2] The name was changed for two reasons. First, the change emphasizes the main problem is not a multitude of personalities, but rather a lack of a single, unified identity[16] and an emphasis on "the identities as centers of information processing".[22] Second, the term "personality" is used to refer to "characteristic patterns of thoughts, feelings, moods and behaviors of the whole individual", while for a patient with DID, the switches between identities and behavior patterns is the personality.[16] It is for this reason the DSM-IV-TR referred to "distinct identities or personality states" instead of personalities. The diagnostic criteria also changed to indicate that while the patient may name and personalize alters, they lack an independent, objective existence.[16] The changes also included the addition of amnesia as a symptom, which was not included in the DSM-III-R because despite being a core symptom of the condition, patients may experience "amnesia for the amnesia" and fail to report it.[22] Amnesia was replaced when it became clear that the risk of false negative diagnoses was low because amnesia was central to DID.[16]

text: The ICD-10 places the diagnosis in the category of "dissociative disorders", within the subcategory of "other dissociative (conversion) disorders", but continues to list the condition as multiple personality disorder.[1]

text: The DSM-IV-TR criteria for DID have been criticized for failing to capture the clinical complexity of DID, lacking usefulness in diagnosing individuals with DID (for instance, by focusing on the two least frequent and most subtle symptoms of DID) producing a high rate of false negatives and an excessive number of DDNOS diagnoses, for excluding possession (seen as a cross-cultural form of DID), and for including only two "core" symptoms of DID (amnesia and self-alteration) while failing to discuss hallucinations, trance-like states, somatoform, depersonalization, and derealization symptoms. Arguments have been made for allowing diagnosis through the presence of some, but not all of the characteristics of DID rather than the current exclusive focus on the two least common and noticeable features.[22] The DSM-IV-TR criteria have also been criticized[citation needed] for being tautological, using imprecise and undefined language and for the use of instruments that give a false sense of validity and empirical certainty to the diagnosis.

text: The DSM-5 updated the definition of DID in 2013, summarizing the changes as:[62]

text: Several changes to the criteria for dissociative identity disorder have been made in DSM-5. First, Criterion A has been expanded to include certain possession-form phenomena and functional neurological symptoms to account for more diverse presentations of the disorder. Second, Criterion A now specifically states that transitions in identity may be observable by others or self-reported. Third, according to Criterion B, individuals with dissociative identity disorder may have recurrent gaps in recall for everyday events, not just for traumatic experiences. Other text modifications clarify the nature and course of identity disruptions.

text: Controversy[edit]

text: DID is among the most controversial of the dissociative disorders, and among the most controversial disorders found in the DSM-IV-TR.[7] The primary dispute is between those who believe DID is caused by traumatic stresses forcing the mind to split into multiple identities, each with a separate set of memories,[4][17] and the belief that the symptoms of DID are produced artificially by certain psychotherapeutic practices or patients playing a role they believe appropriate for a patient suffering from DID.[6][40][42][43][58][63] The debate between the two positions is characterized by intense disagreement.[5][6][15][40][43][58] Psychiatrist Joel Best notes that the idea that a personality is capable of splitting into independent alters is an unproven assertion that is at odds with research in cognitive psychology.[39]

text: Some psychiatrists believe that DID is caused by health care, i.e. symptoms of DID are created by psychiatrists themselves via hypnosis. This belief also implies that those with DID are more susceptible to manipulation by hypnosis and suggestion than others. The iatrogenic model also sometimes states that treatment for DID is harmful. According to Brand, Loewenstein and Spiegel "The claims that DID treatment is harmful are based on anecdotal cases, opinion pieces, reports of damage that are not substantiated in the scientific literature, misrepresentations of the data, and misunderstandings about DID treatment and the phenomenology of DID”. Their claim is evidenced by the fact that only 5%-10% of people receiving treatment worsen in their symptoms.[64]

text: Psychiatrists August Piper and Harold Merskey have challenged the trauma hypothesis, arguing that correlation does not imply causation—the fact that people with DID report childhood trauma does not mean trauma causes DID—and point to the rareness of the diagnosis before 1980 as well as a failure to find DID as an outcome in longitudinal studies of traumatized children. They assert that DID cannot be accurately diagnosed because of vague and unclear diagnostic criteria in the DSM and undefined concepts such as "personality state" and "identities", and question the evidence for childhood abuse beyond self-reports, the lack of definition of what would indicate a threshold of abuse sufficient to induce DID and the extremely small number of cases of children diagnosed with DID despite an average age of appearance of the first alter of three years.[15] Psychiatrist Colin Ross disagrees with Piper and Merskey's conclusion that DID cannot be accurately diagnosed, pointing to internal consistency between different structured dissociative disorder interviews (including the Dissociative Experiences Scale, Dissociative Disorders Interview Schedule and Structured Clinical Interview for Dissociative Disorders)[17] that are in the internal validity range of widely accepted mental illnesses such as schizophrenia and major depressive disorder. In his opinion, Piper and Merskey are setting the standard of proof higher than they are for other diagnoses. He also asserts that Piper and Merskey have cherry-picked data and not incorporated all relevant scientific literature available, such as independent corroborating evidence of trauma.[65]

text: Pathophysiology[edit]

text: Despite research on DID including structural and functional magnetic resonance imaging, positron emission tomography, single-photon emission computed tomography, event-related potential, and electroencephalography, no convergent neuroimaging findings have been identified regarding DID, making it difficult to hypothesize a biological basis for DID. In addition, many of the studies that do exist were performed from an explicitly trauma-based position, and did not consider the possibility of therapy as a cause of DID. There is no research to date regarding the neuroimaging and introduction of false memories in DID patients,[5] though there is evidence of changes in visual parameters[66] and support for amnesia between alters.[5][17] DID patients also appear to show deficiencies in tests of conscious control of attention and memorization (which also showed signs of compartmentalization for implicit memory between alters but no such compartmentalization for verbal memory) and increased and persistent vigilance and startle responses to sound. DID patients may also demonstrate altered neuroanatomy.[19] Experimental tests of memory suggest that patients with DID may have improved memory for certain tasks, which has been used to criticize the hypothesis that DID is a means of forgetting or suppressing memory. Patients also show experimental evidence of being more fantasy-prone, which in turn is related to a tendency to over-report false memories of painful events.[8]

text: Treatment[edit]

text: There is a general lack of consensus in the diagnosis and treatment of DID[5] and research on treatment effectiveness focuses mainly on clinical approaches described in case studies. General treatment guidelines exist that suggest a phased, eclectic approach with more concrete guidance and agreement on early stages but no systematic, empirically-supported approach exists and later stages of treatment are not well described and have no consensus. Even highly experienced therapists have few patients that achieve a unified identity.[67] Common treatment methods include an eclectic mix of psychotherapy techniques, including cognitive behavioral therapy (CBT),[19] insight-oriented therapies,[17] dialectical behavioral therapy (DBT), hypnotherapy and eye movement desensitization and reprocessing (EMDR). Medications can be used for comorbid disorders or targeted symptom relief.[10][42] Some behavior therapists initially use behavioral treatments such as only responding to a single identity, and then use more traditional therapy once a consistent response is established.[68] Brief treatment due to managed care may be difficult, as individuals diagnosed with DID may have unusual difficulties in trusting a therapist and take a prolonged period to form a comfortable therapeutic alliance.[10] Regular contact (weekly or biweekly) is more common, and treatment generally lasts years—not weeks or months.[10][19] Sleep hygiene has been suggested as a treatment option, but has not been tested. In general there are very few clinical trials on the treatment of DID, none of which were randomized controlled trials.[8]

text: Therapy for DID is generally phase oriented.[29] Different alters may appear based on their greater ability to deal with specific situational stresses or threats. While some patients may initially present with a large number of alters, this number may reduce during treatment—though it is considered important for the therapist to become familiar with at least the more prominent personality states as the "host" personality may not be the "true" identity of the patient. Specific alters may react negatively to therapy, fearing the therapists goal is to eliminate the alter (particularly those associated with illegal or violent activities). A more realistic and appropriate goal of treatment is to integrate adaptive responses to abuse, injury or other threats into the overall personality structure.[19] There is debate over issues such as whether exposure therapy (reliving traumatic memories, also known as abreaction), engagement with alters and physical contact during therapy is appropriate and there are clinical opinions both for and against each option with little high-quality evidence for any position.

text: Brandt et al., noting the lack of empirical studies of treatment effectiveness, conducted a survey of 36 clinicians expert in treating dissociative disorder (DD) who recommended a three-stage treatment. They agreed that skill building in the first stage is important so the patient can learn to handle high risk, potentially dangerous behavior, as well as emotional regulation, interpersonal effectiveness and other practical behaviors. In addition, they recommended "trauma-based cognitive therapy" to reduce cognitive distortions related to trauma; they also recommended that the therapist deal with the dissociated identities early in treatment. In the middle stage, they recommended graded exposure techniques, along with appropriate interventions as needed. The treatment in the last stage was more individualized; few with DD  [sic] became integrated into one identity.[67]

text: The International Society for the Study of Trauma and Dissociation has published guidelines to phase-oriented treatment in adults as well as children and adolescents that are widely used in the field of DID treatment.[non-primary source needed][10] The first phase of therapy focuses on symptoms and relieving the distressing aspects of the condition, ensuring the safety of the individual, improving the patient's capacity to form and maintain healthy relationships, and improving general daily life functioning. Comorbid disorders such as substance abuse and eating disorders are addressed in this phase of treatment.[10] The second phase focuses on stepwise exposure to traumatic memories and prevention of re-dissociation. The final phase focuses on reconnecting the identities of disparate alters into a single functioning identity with all its memories and experiences intact.[10]

text: A study was conducted with the goal of developing an "expertise-based prognostic model for the treatment of complex posttraumatic stress disorder (PTSD) and dissociative identity disorder (DID)". Researchers constructed a two-stage survey and factor analyses performed on the survey elements found 51 factors common to complex PTSD and DID. The authors concluded from their findings: "The model is supportive of the current phase-oriented treatment model, emphasizing the strengthening of the therapeutic relationship and the patient's resources in the initial stabilization phase. Further research is needed to test the model's statistical and clinical validity."[69]

text: Prognosis[edit]

text: Little is known about prognosis of untreated DID.[9] It rarely, if ever, goes away without treatment,[3][21] but symptoms may resolve from time to time[3] or wax and wane spontaneously.[21] Patients with mainly dissociative and posttraumatic symptoms face a better prognosis than those with comorbid disorders or those still in contact with abusers, and the latter groups often face lengthier and more difficult treatment. Suicidal ideation, failed suicide attempts, and self-harm also occur.[21] Duration of treatment can vary depending on patient goals, which can extend from elimination of all alters to merely reducing inter-alter amnesia, but generally takes years.[21]

text: Epidemiology[edit]

text: There is little systematic data on the prevalence of DID.[70] It occurs more commonly in young adults[70] and declines with age.[71] Reported rates in the community vary from 1% to 3% with higher rates among psychiatric patients.[10][16] It is 5 to 9 times more common in females than males during young adulthood, though this may be due to selection bias as males who could be diagnosed with DID may end up in the criminal justice system rather than hospitals.[7] In children rates among females and males are approximately the same (5:4).[3] DID diagnoses are extremely rare in children; much of the research on childhood DID occurred in the 1980s and 1990s and does not address ongoing controversies surrounding the diagnosis.[32]

text: Though the condition has been described in non-English speaking nations and non-Western cultures, these reports all occur in English-language journals authored by international researchers who cite Western scientific literature and are therefore not isolated from Western influences.[32]

text: Changing prevalence[edit]

text: Rates of diagnosed DID were increasing, reaching a peak of approximately 40,000 cases by the end of the 20th century, up from less than 200 before 1970.[3][7] Initially DID along with the rest of the dissociative disorders were considered the rarest of psychological conditions, numbering less than 100 by 1944, with only one further case added in the next two decades.[17] In the late 1970s and 80s, the number of diagnoses rose sharply.[17] An estimate from the 1980s places the incidence at 0.01%.[3] Accompanying this rise was an increase in the number of alters, rising from only the primary and one alter personality in most cases, to an average of 13 in the mid-1980s (the increase in both number of cases and number of alters within each case are both factors in professional skepticism regarding the diagnosis).[17] Others explain the increase as being due to the use of inappropriate therapeutic techniques in highly suggestible individuals, though this is itself controversial[6][43] while proponents of DID claim the increase in incidence is due to increased recognition of and ability to recognize the disorder.[7] Figures from psychiatric populations (inpatients and outpatients) show a wide diversity from different countries.[72]

text: North America[edit]

text: The DSM does not provide an estimate of incidence for DID and dissociative disorders were excluded from the Epidemiological Catchment Area Project. As a result, there are no national statistics for prevalence and incidence of DID in the United States.[17]

text: DID is a controversial diagnosis and condition, with much of the literature on DID still being generated and published in North America, to the extent that it was once regarded as a phenomenon confined to that continent[40][73] though research has appeared discussing the appearance of DID in other countries and cultures.[74] A 1996 review offered three possible causes for the sudden increase in people diagnosed with DID:[11]

text:
The result of therapist suggestions to suggestible people, much as Charcot's hysterics acted in accordance with his expectations.
Psychiatrists' past failure to recognize dissociation being redressed by new training and knowledge.
Dissociative phenomena are actually increasing, but this increase only represents a new form of an old and protean entity: "hysteria".

tag: ol

text: Paris believes that the first possible cause is the most likely. Etzel Cardena and David Gleaves believe the over-representation of DID in North America is the result of increased awareness and training about the condition which had formerly been missing.[16]

text: History[edit]

text: The first case of DID was thought to be described by Paracelsus in 1646.[12] In the 19th century, "dédoublement" or double consciousness, the historical precursor to DID, was frequently described as a state of sleepwalking, with scholars hypothesizing that the patients were switching between a normal consciousness and a "somnambulistic state".[31]

text: An intense interest in spiritualism, parapsychology and hypnosis continued throughout the 19th and early 20th centuries,[73] running in parallel with John Locke's views that there was an association of ideas requiring the coexistence of feelings with awareness of the feelings.[75] Hypnosis, which was pioneered in the late 18th century by Franz Mesmer and Armand-Marie Jacques de Chastenet, Marques de Puységur, challenged Locke's association of ideas. Hypnotists reported what they thought were second personalities emerging during hypnosis and wondered how two minds could coexist.[73]

text: In the 19th century there were a number of reported cases of multiple personalities which Rieber[75] estimated would be close to 100. Epilepsy was seen as a factor in some cases,[75] and discussion of this connection continues into the present era.[76][77]

text: By the late 19th century, there was a general acceptance that emotionally traumatic experiences could cause long-term disorders which might display a variety of symptoms.[78] These conversion disorders were found to occur in even the most resilient individuals, but with profound effect in someone with emotional instability like Louis Vivet (1863-?) who suffered a traumatic experience as a 17-year-old when he encountered a viper. Vivet was the subject of countless medical papers and became the most studied case of dissociation in the 19th century.

text: Between 1880 and 1920, various international medical conferences devoted time to sessions on dissociation.[79] It was in this climate that Jean-Martin Charcot introduced his ideas of the impact of nervous shocks as a cause for a variety of neurological conditions. One of Charcot's students, Pierre Janet, took these ideas and went on to develop his own theories of dissociation.[80] One of the first individuals diagnosed with multiple personalities to be scientifically studied was Clara Norton Fowler, under the pseudonym Christine Beauchamp; American neurologist Morton Prince studied Fowler between 1898 and 1904, describing her case study in his 1906 monograph, Dissociation of a Personality.[80][81]

text: In the early 20th century, interest in dissociation and multiple personalities waned for a number of reasons. After Charcot's death in 1893, many of his so-called hysterical patients were exposed as frauds, and Janet's association with Charcot tarnished his theories of dissociation.[73] Sigmund Freud recanted his earlier emphasis on dissociation and childhood trauma.[73]

text: In 1908, Eugen Bleuler introduced the term schizophrenia to represent a revised disease concept for Emil Kraepelin's dementia praecox.[82] Whereas Kraepelin's natural disease entity was anchored in the metaphor of progressive deterioration and mental weakness and defect, Bleuler offered a reinterpretation based on dissociation or "splitting' (Spaltung) and widely broadened the inclusion criteria for the diagnosis. A review of the Index medicus from 1903 through 1978 showed a dramatic decline in the number of reports of multiple personality after the diagnosis of schizophrenia became popular, especially in the United States.[83] The rise of the broad diagnostic category of dementia praecox has also been posited in the disappearance of "hysteria" (the usual diagnostic designation for cases of multiple personalities) by 1910.[84] A number of factors helped create a large climate of skepticism and disbelief; paralleling the increased suspicion of DID was the decline of interest in dissociation as a laboratory and clinical phenomenon.[79]

text: Starting in about 1927, there was a large increase in the number of reported cases of schizophrenia, which was matched by an equally large decrease in the number of multiple personality reports.[79] With the rise of a uniquely American reframing of dementia praecox/schizophrenia as a functional disorder or "reaction" to psychobiological stressors—a theory first put forth by Adolf Meyer in 1906—many trauma-induced conditions associated with dissociation, including "shell shock" or "war neuroses" during World War I, were subsumed under these diagnoses.[82] It was argued in the 1980s that DID patients were often misdiagnosed as suffering from schizophrenia.[79]

text: The public, however, was exposed to psychological ideas which took their interest. Mary Shelley's Frankenstein, Robert Louis Stevenson's Strange Case of Dr Jekyll and Mr Hyde, and many short stories by Edgar Allan Poe had a formidable impact.[75] In 1957, with the publication of the bestselling book The Three Faces of Eve by psychiatrists Corbett H. Thigpen and Hervey M. Cleckley, based on a case study of their patient Chris Costner Sizemore, and the subsequent popular movie of the same name, the American public's interest in multiple personality was revived. More cases of dissociative identity disorder were diagnosed in the following years.[85] The cause of the sudden increase of cases is indefinite, but it may be attributed to the increased awareness, which revealed previously undiagnosed cases or new cases may have been induced by the influence of the media on the behavior of individuals and the judgement of therapists.[85] During the 1970s an initially small number of clinicians campaigned to have it considered a legitimate diagnosis.[79]

text: Between 1968 and 1980, the term that was used for dissociative identity disorder was "Hysterical neurosis, dissociative type". The APA wrote in the second edition of the DSM: "In the dissociative type, alterations may occur in the patient's state of consciousness or in his identity, to produce such symptoms as amnesia, somnambulism, fugue, and multiple personality."[61] The number of cases sharply increased in the late 1970s and throughout the 80s, and the first scholarly monographs on the topic appeared in 1986.[17]

text: In 1974, the highly influential book Sybil was published, and later made into a miniseries in 1976 and again in 2007. Describing what Robert Rieber called "the third most famous of multiple personality cases",[86] it presented a detailed discussion of the problems of treatment of "Sybil", a pseudonym for Shirley Ardell Mason. Though the book and subsequent films helped popularize the diagnosis and trigger an epidemic of the diagnosis,[39] later analysis of the case suggested different interpretations, ranging from Mason's problems being caused by the therapeutic methods used by her psychiatrist, Cornelia B. Wilbur or an inadvertent hoax due in part to the lucrative publishing rights,[86][87] though this conclusion has itself been challenged.[88] Dr. David Spiegel, a Stanford psychiatrist whose father treated Shirley Ardell Mason on occasion, says that his father described Mason as "a brilliant hysteric. He felt that Dr. Wilbur tended to pressure her to exaggerate on the dissociation she already had."[89] As media attention on DID increased, so too did the controversy surrounding the diagnosis.[12]

text: With the publication of the DSM-III, which omitted the terms "hysteria" and "neurosis" (and thus the former categories for dissociative disorders), dissociative diagnoses became "orphans" with their own categories[90] with dissociative identity disorder appearing as "multiple personality disorder".[17] In the opinion of McGill University psychiatrist Joel Paris, this inadvertently legitimized them by forcing textbooks, which mimicked the structure of the DSM, to include a separate chapter on them and resulted in an increase in diagnosis of dissociative conditions. Once a rarely occurring spontaneous phenomenon (research in 1944 showed only 76 cases),[91] became "an artifact of bad (or naïve) psychotherapy" as patients capable of dissociating were accidentally encouraged to express their symptoms by "overly fascinated" therapists.[90]

text: In a 1986 book chapter (later reprinted in another volume), philosopher of science Ian Hacking focused on multiple personality disorder as an example of "making up people" through the untoward effects on individuals of the "dynamic nominalism" in medicine and psychiatry. With the invention of new terms entire new categories of "natural kinds" of people are assumed to be created, and those thus diagnosed respond by re-creating their identity in light of the new cultural, medical, scientific, political and moral expectations. Hacking argued that the process of "making up people" is historically contingent, hence it is not surprising to find the rise, fall, and resurrection of such categories over time.[92] Hacking revisited his concept of "making up people" in an article published in the London Review of Books on 17 August 2006.[93]

text: "Interpersonality amnesia" was removed as a diagnostic feature from the DSM III in 1987, which may have contributed to the increasing frequency of the diagnosis.[17] There were 200 reported cases of DID as of 1980, and 20,000 from 1980 to 1990.[94] Joan Acocella reports that 40,000 cases were diagnosed from 1985 to 1995.[95] Scientific publications regarding DID peaked in the mid-1990s then rapidly declined.[96]

text: There were several contributing factors to the rapid decline of reports of multiple personality disorder/dissociative identity disorder. One was the discontinuation in December 1997 of Dissociation: Progress in the Dissociative Disorders, the journal of The International Society for the Study of Multiple Personality and Dissociation.[97] The society and its journal were perceived as uncritical sources of legitimacy for the extraordinary claims of the existence of intergenerational satanic cults responsible for a "hidden holocaust"[98] of Satanic ritual abuse that was linked to the rise of MPD reports. In an effort to distance itself from the increasing skepticism regarding the clinical validity of MPD, the organization dropped "multiple personality" from its official name in 1993, and then in 1997 changed its name again to the International Society for the Study of Trauma and Dissociation.

text: In 1994, the fourth edition of the DSM replaced the criteria again and changed the name of the condition from "multiple personality disorder" to the current "dissociative identity disorder" to emphasize the importance of changes to consciousness and identity rather than personality. The inclusion of interpersonality amnesia helped to distinguish DID from dissociative disorder not otherwise specified, but the condition retains an inherent subjectivity due to difficulty in defining terms such as personality, identity, ego-state and even amnesia.[17] The ICD-10 still classifies DID as a "Dissociative [conversion] disorder" and retains the name "multiple personality disorder" with the classification number of F44.8.81.[1]

text: A 2006 study compared scholarly research and publications on DID and dissociative amnesia to other mental health conditions, such as anorexia nervosa, alcohol abuse and schizophrenia from 1984 to 2003. The results were found to be unusually distributed, with a very low level of publications in the 1980s followed by a significant rise that peaked in the mid-1990s and subsequently rapidly declined in the decade following. Compared to 25 other diagnosis, the mid-90's "bubble" of publications regarding DID was unique. In the opinion of the authors of the review, the publication results suggest a period of "fashion" that waned, and that the two diagnoses "[did] not command widespread scientific acceptance".[96]

text: Society and culture[edit]

text: Despite its rareness, DID is portrayed with remarkable frequency in popular culture, producing or appearing in numerous books, films, and television shows.[43]

text: Psychiatrist Colin A. Ross has stated that based on documents obtained through freedom of information legislation, psychiatrists linked to Project MKULTRA claimed to be able to deliberately induce dissociative identity disorder using a variety of aversive techniques.[100]

text: Surveys of the attitudes of Canadian and American psychiatrists towards dissociative disorders completed in 1999[63] and 2001[101] found considerable skepticism and disagreement regarding the research base of dissociative disorders in general and DID in specific, as well as whether the inclusion of DID in the DSM was appropriate.

text: NFL player Herschel Walker published an autobiography in 2008 discussing his life and diagnosis of DID.[102]

text: Legal issues[edit]

text: Within legal circles, DID has been described as one of the most disputed psychiatric diagnoses and forensic assessments.[5] The number of court cases involving DID has increased substantially since the 1990s[14] and the diagnosis presents a variety of challenges for legal systems. Courts must distinguish individuals who mimic symptoms of DID for legal or social reasons. Within jurisprudence there are three significant problems:[5]

text:
Individuals diagnosed with DID may accuse others of abuse, but lack objective evidence and base their accusations solely on regular or recovered memories.
There are questions regarding the civil and political rights of alters, particularly which alter can legally represent the person, sign a contract or vote.
Finally, individuals diagnosed with DID who are accused of crimes may deny culpability on the grounds that the crime was committed by a different identity-state.

text: In cases where not guilty by reason of insanity (NGRI) is used as a defence in a court, it is normally accompanied by one of three legal approaches—claiming a specific alter was in control when the crime was committed (and if that alter is considered insane), deciding whether all (or which) alters may be insane, or whether only the dominant personality meets the insanity standard.[12] NGRI is rarely successful for individuals with DID accused of committing crimes while in a dissociated state.[13]

text: There is no agreement within the legal and mental health fields whether an individual can be acquitted due to a diagnosis of DID. It has been argued that any individual with DID is a single person with a serious mental illness and therefore exhibits diminished responsibility and this was first recognized in an American court in 1978 (State v. Milligan). However, public reaction to the result of the case was strongly negative and since that time the few cases claiming insanity have found that the altered consciousness found in DID is either irrelevant or the diagnosis was not admissible evidence.[12] The self-reported nature of the symptoms used to reach a diagnosis makes it difficult to determine their credibility, although objective measuring of brain activation and structural patterns are a promising direction for future scientific research into distinguishing malingered from genuine DID in forensic settings.[5] Forensic experts called on to conduct forensic examinations for DID must use a multidisciplinary approach including multiple screening instruments.[12]


document_title: In the Heat of the Night (Ray Charles song)

question_text: who sang the theme song for in the heat of the night

text: This article needs additional citations for verification. Please help improve this article by adding citations to reliable sources. Unsourced material may be challenged and removed. (April 2016) (Learn how and when to remove this template message)

text: "In the Heat of the Night" is a 1967 song performed by Ray Charles, composed by Quincy Jones, and written by Marilyn Bergman and Alan Bergman for the film In the Heat of the Night. As Matthew Greenwald of AllMusic states, the song "opens the film and accompanying soundtrack with a slice of real, rural backwoods gospel. Lyrically, one of the key lines is 'In the heat of the night/I'm feeling motherless somehow,' which clearly illustrates the main character's dilemma of being in the wrong place at the wrong time. The main melody is guided by Charles' funky piano work and is buttressed by then-session ace Billy Preston's powerful, soulful organ trills. The underlying sense of drama that is so much a part of the film is reflected perfectly in this song, and the Ray Charles Singers add to this with a stately grace. It's perfect listening for a midsummer night when the temperature is just a bit too hot for comfort."[1]

text: Released as a single by ABC Records, Charles' version of the song reached #33 on the Billboard Hot 100 chart and #21 on the Hot Rhythm & Blues Singles chart. The song was also released on the soundtrack album on United Artists in 1967.

text: For the 1988–95 television series of the same name, the song was recorded by Bill Champlin.