Looping kinds and dynamic nominalism: the feedback loop of diagnostic labels and cultural influences in DID

I am a critic of the diagnosis of dissociative identity disorder. Although I accept that I have the underlying disorder that the label of DID is attempting to describe, I strongly disagree with how the disorder is understood, conceptualized, and portrayed. It took me a long time to accept this, and I was very confused by what DID was and how it presents for over a year after my diagnosis. It was only once I realized that I am experiencing the exact same things that others who present their disorder as being more florid are experiencing, I’m just interpreting and portraying my experiences differently did this diagnosis make sense to me—I am not someone who is dramatic or easily influenced by culture, yet culture greatly influences how DID presents. There are two concepts that describe this understanding well, which were conceptualized by the late philosopher Ian Hacking that will be discussed in this post: looping kinds and dynamic nominalism.

Looping kinds and dynamic nominalism both explore the relationship between classifications and the phenomena they describe, but they differ in how they view this relationship. Looping kinds refers to the feedback loop where a classification not only describes a phenomenon but also actively shapes it¹. For example, the term “hacker” initially described individuals with a deep understanding of computers who could manipulate systems at a technical level, often for purposes of exploration or exploitation. However, as more people began identifying as hackers, the definition expanded to include those who may not have extensive technical knowledge but still engage in hacking activities, such as running pre-made scripts or exploiting well-known security vulnerabilities. This shift in the definition encouraged others, including those with limited technical expertise, to identify as hackers as well, further broadening the category and reshaping both individual self-perception and societal views of what it means to be a hacker. In this way, the hacker identity creates an ongoing feedback loop, where those who identify within the category actively shape the category itself.

Dynamic nominalism focuses on the power of naming and categorization itself, suggesting that introducing or changing a label actively shapes and even brings into existence the phenomena it seeks to describe. For example, the expansion of the diagnosis of autism transformed how both individuals and society understands autism. Initially, autism was primarily associated with severe impairments in social communication and intellectual functioning, with little room for those who exhibited milder traits. However, as the classification of autism broadened to include a wider spectrum of traits, new “kinds” of autism emerged in the process. Notably, the concept of “high-functioning autism” was introduced to describe individuals with within the new definition of autism who had average or above-average intellectual abilities. Similarly, the category of “female autism” gained prominence as more women and girls were diagnosed with autism, despite often displaying subtler symptoms that did not fit the traditional male-associated profile. These new kinds of autism were not merely reflections of pre-existing phenomena—they are products of the evolving diagnostic label itself. In this way, the expanded classification of autism did not just describe a broader range of traits but actively created new “kinds” of individuals, shaping both societal expectations and individual experiences of autism. This illustrates dynamic nominalism, where the introduction or change of a label brings new kinds of people into being simultaneously as the labels themselves transform the reality they describe.

In the context of DID, the concepts of looping kinds and dynamic nominalism can be illustrated through various examples. One prominent illustration of looping kinds is how DID is labeled as an “identity disorder”, which intertwines the diagnosis with an individual’s sense of self. This labeling can lead those diagnosed to view their experiences primarily through the lens of having multiple identities, causing them to over-identify with their symptoms as integral to their identity. This over-identification can hinder therapeutic interventions aimed at integration or change, as individuals may fear that such treatment will erase a crucial part of who they are. By labeling DID as an identity disorder, those diagnosed with it are likely to view their experiences within the multiple identities framework, which further reinforces labeling DID as an identity disorder since many diagnosed with it use this pre-defined conceptualization. This dynamic illustrates how the classification of DID not only influences self-perception but also creates a feedback loop that reinforces and perpetuates the symptoms as part of the individual’s identity. Conversely, dynamic nominalism highlights how the terminology itself actively shapes both societal understanding and the experience of the disorder. When DID is labeled as an “identity disorder”, it creates a framework for thinking about individuals in terms of identity fragmentation. This new kind of person—the “person with multiple identities”—emerges alongside the label itself, shaping how both individuals and society conceptualize DID. As a result, the label doesn’t merely reflect an existing phenomenon—it actively creates new ways of understanding and responding to dissociation, influencing therapy, treatment, and societal perceptions in a manner that would not have occurred without the label’s introduction. Thus, the label of DID as an “identity disorder” demonstrates both concepts: looping kinds through the way the DID label shapes self-perception and reinforces the symptoms as part of identity, and dynamic nominalism through the creation of a new “kind” of person defined by the label, which reshapes societal understanding and treatment of the disorder.

Cultural influences play a significant role in shaping the presentation and understanding of DID. Media portrayals, societal expectations, and cultural narratives profoundly impact how symptoms of DID are expressed and interpreted. For instance, sensationalized depictions of DID in social media, films, and literature often highlight dramatic manifestations, such as individuals with multiple distinct “alters” or visible shifts in personality. These portrayals illustrate dynamic nominalism, as the existence of the DID label not only shapes societal expectations but also actively creates new ways of understanding and interpreting one’s internal experiences. The introduction and popularization of the DID label associated with these dramatic presentations has led to the emergence of a kind of person—the individual with multiple identities—shaping cultural narratives around the disorder in ways that typically don’t actually reflect the underlying dissociative phenomena accurately. As these portrayals gain cultural traction, they shape both individual experiences and societal expectations. Consequently, individuals diagnosed with DID may feel pressured to conform to these exaggerated representations, leading them to emphasize dramatic aspects of their condition to align with cultural expectations. This feedback loop exemplifies looping kinds, as the label reinforces certain symptom patterns, shaping how individuals experience their condition and how the condition is understood and treated by society. Cultural influences extend beyond individual experiences, shaping societal perceptions and clinical interpretations of DID as a whole, illustrating the intricate interplay between cultural narratives, diagnostic labels, and individual experience.

Another example of looping kinds in DID is the practice of assigning one’s alters, or compartmentalized internal states, specific names, ages, genders, appearances, and other personifying characteristics. These attributes are not innate aspects of the phenomenological experience that the label of DID is attempting to describe; rather, they are entirely constructed by cultural and clinical practices. Media portrayals and clinical conventions that emphasize the personification of alters contribute to this phenomenon, creating a feedback loop where this practice becomes entrenched in the understanding of DID. Although the personification of alters with specific traits is often presented as inherent to DID, this is actually entirely a cultural interpretation rather than any fundamental aspect of the disorder. This cultural understanding has become so influential that most sources describing DID assert that alters inherently possess these personifying characteristics. In reality, individuals who conceptualize DID using this most dominant cultural understanding assign these characteristics to themselves and their perceived alters because that’s what the cultural narrative dictates. And because this practice is so pervasive in the understanding of DID, individuals may not even realize that their self-concept is being heavily influenced by these arbitrary cultural practices, adopting the accepted narrative that their “multiple identities” are inherently who they are. The attribution of names, ages, genders, and other personifying characteristics to alters is entirely a product of our culture, but because it’s so pervasive in the culture it significantly shapes the conceptualization of DID—a clear illustration of looping kinds.

As a final example, the reclassification of Multiple Personality Disorder (MPD) to Dissociative Identity Disorder (DID) exemplifies dynamic nominalism. This shift significantly influenced how the disorder was perceived and treated by changing the diagnostic label from MPD, which focused on distinct and dramatic alters, to DID, which emphasizes identity fragmentation and dissociation. Under the label of MPD, the disorder was typically understood as involving overt, sensationalized presentations, often characterized by a few clearly defined alters. However, the transition to DID created a broader and more nuanced understanding of the disorder, recognizing a wider spectrum of symptoms and a potentially greater number of alters. This reclassification shifted the focus from dramatic manifestations to more subtle forms of internal fragmentation, leading to expanded diagnostic criteria and changes in clinical practice. Through this shift in terminology, the label itself helped shape not only the clinical understanding but also the societal perception of the disorder. As the label of DID became more established, it created a new kind of person—one whose experiences of identity fragmentation were recognized as legitimate and worthy of treatment, regardless of how overt or dramatic those experiences were. This transformation shows the dynamic nature of labeling in mental health diagnoses, illustrating how changes in diagnostic categories reshape both individual and societal understandings, reinforcing new expectations, and influencing treatment approaches.

Together, these concepts highlight the complex interplay between diagnostic labels and the experience of mental health disorders. Looping kinds describes how a diagnosis shapes individual self-perception and symptom presentation, creating a feedback loop between the label and the individual. Dynamic nominalism, in contrast, is the idea that the act of naming or changing a label doesn’t merely describe an existing phenomenon, but actively participates in shaping and creating that phenomenon, with the concept and the reality it describes developing in tandem. In the case of DID, both concepts illustrate how diagnostic classifications influence not only how the disorder is experienced and understood, but also how it is conceptualized and treated in clinical and societal contexts².

I am a fan of Ian Hacking, and I strongly believe that anybody with a dissociative disorder diagnosis, or those interested in dissociative disorders or other mental health conditions, should learn more about his work. He is an agnostic observer of DID—in his writings, he presents philosophical arguments without directly advocating for or against any particular belief system, although it is clear he believes that this disorder is a cultural phenomena. His work has clarified my understanding of DID and has validated my observations of the disorder in a way that no other source has. If you’re interested in learning more, I highly suggest his book Rewriting the Soul, but the book The Social Construction of What? is also insightful in this space. Hacking also wrote extensively on a variety of topics during his life, including the philosophy of sciences and mathematics, which are interesting to me. A good review of his work can be found in his New York Times eulogy, here.