"In the online community, there appear to be three main groups: people with traumagenic, traditional, clinical DID or partial DID or OSDD; people with false positive, malingering, factitious, or imitating DID, or sociogenic¹ DID; and people who identify as Plural, though they neither suffer from DID nor are distressed by plurality, but who find it helpful to refer to themselves as "Plurals". The bulk of research is for the first group,... only just now being published on the latter two groups. However, all three groups should still receive appropriate clinical treatment according to current research and guidelines specific to their presentation."

On Plural culture:

"These online support groups, discussion threads, resources, and shared experiences have evolved over the years into a more organized state both linguistically and politically, making Plurality its own culture"

"Regardless of years of experience, knowledge of models, and technique, it is difficult for the clinician to ethically treat a patient from a culture of which the clinician is unaware or denies."

The APA's (2017) Clinical Practice Guideline for the Treatment of Posttraumatic Stress Disorder (PTSD) in Adults specifically states that attention to cultural context is a required component of trauma-informed mental health care."

(this refers to how Plurals may enter therapy for related or unrelated issues, so Plural culture must be understood by the clinician.)

"This [Plural] group tends to have a very developed sense of political identity as Plurals and they present very differently in session than those with dissociative disorders."

"Traditional, traumagenic cases of DID have been well-documented and well-researched, with recommendations for treatment that include a phase-based and psychodynamic treatment model according to current guidelines."

On sociogeny:

"Cases of sociogenic plurality* are only just now being discussed in literature. They are distinct from traumagenic cases, and current guidelines do not apply for those reasons."

1: From WikiPedia:

Sociogeny or sociogenesis is the development of a social phenomenon.

*: from the article's 'citation excerpt' where it's stated that, due to data being collected in 2016, this paper doesn't account for the 2020 SysTok boom...

"What Christensen (2022) describes as: the sociogenic phenomenon of online presentations of people self-identifying as having dissociative identity disorder (and/or as plural) whose presentation and history may be inconsistent with a traditional, traumagenic dissociative identity disorder diagnoses."

About clinical perspectives:

"While many patients may have little to no interaction with the online Plural community, an increasing number of them will, due to younger generations' organic fluency in the online world. Lacking awareness of the development of the online community as culture for trauma survivors, and Plurals specifically, at this point could be considered maleficence, while educating oneself on the dynamic of the online community becomes simple beneficence."

"Within this framework, the Plural community called for collaboration with the clinical community to prevent and reduce ruptures in the therapeutic alliance, to co-lead solutions, and to accept lived experience as the best understanding of barriers to treatment. They also formally requested to be included in the revising of treatment guidelines, as well as giving fair compensation and credit for their participation in research."

About DID and ongoing developments in the clinical field:

"...miscommunication when people are using the same words for different things, This is still being reviewed, with Steele (2021) returning to more ego state language, and van der Hart (2021) shifting to degrees of dissociation and reporting that: "dissociative parts of the personality may comprise any number of psychobiological states, which implies that labeling them ego-states or self-states is giving them a too low degree of reality.""

From Google, psychobiology is:

The branch of psychology that interprets psychological phenomena in terms of adaptation to biological, environmental etc. factors

What's fMRI?

"the research confirming DID as a trauma-based disorder is doing just that: confirming traumagenic DID, the disorder, not Plurality, the identity. Reinders (2020) research demonstrating diagnostic capability with fMRI* differentiates already between DID and personality disorders, as well as DID and malingering, as do the common assessments available for dissociative disorders."

Developed: early 1990s

functional magnetic resonance imaging (fMRI) is a type of noninvasive brain imaging technology that takes images of your brain’s activity while it’s performing a particular function.

An fMRI can reveal what part of the brain is active, during tasks like: lifting your arm or even just thinking about something.

An fMRI can “see” thoughts and feelings, essentially creating a functional map on top of the brain images.

Clinicians may be overly concerned about the instances of such cases, with Plurals under-concerned about such cases. The balance is found in considering what a person has endured already, to need to go to such lengths in order to receive the support they need? Even clinically, if support is what a client needs, that is a simple treatment in response.

"There are some Plurals who may be malingering or fictitious and not have DID or a cultural expression of plurality, but only faking DID to receive support.

Other cases may involve a rich inner fantasy life that is not the same as experiencing plurality, but the person may not have other ways to express it or other people who understand that experience, and so resonate with the Plural community."

Some finishing quotes from the article:

"The role of the therapist in this enterprise is to guide the client through the process of thinking something through to a conclusion, while leaving the outcome or actual conclusion in the hands of the client" (Gold, 2009)."

"To accept is not to be passively resigned or hopeless, but to be actively involved in understanding things as they are, rather than as one wishes or demands they should be (Follette et al., 2009, p. 272). Understanding things as they are will be a big part of future research in the field of trauma and dissociation."