During abuse, emotional outbursts such as crying and responses to pain, which were originally respondent behaviors (Fordyce, 1976; Rachlin, 1985; Turk & Rudy, 1990), caused still more abuse and therefore came under control of avoidance and escape contingencies (Kohlenberg & Tsai, 1991). Pain-inflicted crying led to more pain being inflicted. Crying, smiling, and other emotional displays, which were originally respondents, could come to be under the control of operant contingencies, in an attempt to avoid further punishment. In addition, the care giver's abuse may have been erratic and difficult to predict but was still the focus of attempts by the abused person to predict and avoid further abuse. As a result, the abuse victim may have come to exhibit behaviors and emotions capriciously and histrionically; at other times, virtually no affect would be exhibited. These attempts at self-control from the erratic stimulus events and contingencies were probably not often successful in avoiding or escaping abuse. The person being abused could never learn to predict what events produced or avoided abuse or reinforcement (love) and increasingly would come to attend to him- or herself since other individuals provided unreliable antecedent events as occasions for how to behave.
In the present, however, the former victim has potentially "heightened" operant control of emotions and personality behaviors when confronted with uncertainty or stimulus conditions reminiscent of the past. These individuals are often very skilled at altering their personality repertoires to control others (Spanos, 1994). Kohlenberg & Tsai (1991) reported that these individuals are vigilant and actively attentive to the therapist's discriminative stimuli as to what behaviors will be reinforced or punished. At the same time, different personalities may be displayed with no obvious change in any public, environmental stimuli.
Some writers report that this disorder may only become apparent to a professional or others when "different people" attend meetings, interviews, or therapy; that is, the same individual attends but with a different self-report of identity, memories, and personality behaviors (Sackheim & Devanand, 1991). In so doing, individuals displaying these behaviors can receive a great deal of reinforcing attention from professionals for engaging in these behaviors.
Individuals demonstrating behaviors correlated with a diagnosis of DID may be reassured of no further abuse and may be encouraged to try to "be themselves" in as many ways as they “need” to be. The different self-reports and personality repertoires become a source of reinforcement for the formerly abused victims and the professional alike (Spanos, 1994). The risk here is that the verbal repertoires of a person with degrees of behavioral variability could be shaped iatrogenically to reporting to be a divergent person by professionals zealously looking for this disorder (Fahy, 1988; Merskey, 1992). To quote one skeptical critic, "the procedures used to diagnose MPD often create rather than discover multiplicity," (Spanos, p. 153).
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