The thesis that DID is merely a North American phenomenon has been refuted in the past decade by research reports based on standardized assessment from diverse countries, such as from The Netherlands, Turkey, and Germany (Boon & Draijer, 1993; Gast, Rodewald, Nickel, & Emrich, 2001; S ̧ar et al, 1996). Clinicians and researchers should be careful to avoid categorizing a universal human condition as culture-bound.

My own studies on the natural history of DID indicate only 20% of DID patients have an overt DID adaption on a chronic basis, and 14% of them deliberately disguise their manifestations of DID. Only 6% make their DID obvious on an ongoing basis. Eighty percent have windows of diagnosability when stressed or triggered by some significant event, interaction, situation or date. Therefore, 94% of DID patients show only mild or suggestive evidence of their conditions most of the time. Yet DID patients often will acknowledge that their personality systems are actively switching and/or far more active than it would appear on the surface (Loewenstein et al., 1987).R.P. Kluft (2009) A clinician's understanding of dissociation. pp 599-623.