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              Dissociative identity disorder

A dissociative disorder characterized by the presence in one individual of two or more distinct identities or personality states that each recurrently takes control of the individual’s behavior. It is believed to be associated with severe physical and sexual abuse, especially during childhood. Despite an increase in reported cases in the united states since the 1970s, DID remains the subject of considerable controversy, with many disputing its validity as a diagnosis and citing the incidences of childhood abuse reported by diagnosed individuals or their therapists as cases of false memory. DID is still commonly known as multiple personality disorder.

What is dissociative identity disorder?

Dissociative identity disorder is a severe form of dissociation, a mental process which produces a lack of connection in a person's thoughts, memories, feelings, actions, or sense of identity. Dissociative identity disorder is thought to stem from a combination of factors that may include trauma experienced by the person with the disorder. The dissociative aspect is thought to be a coping mechanism -- the person literally shuts off or dissociates themselves from a situation or experience that's too violent, traumatic, or painful to assimilate with their conscious self.

Brief history

Dr. Jean-Martin Charcot, chief physician at Salpetriere Hospital in Paris though he had discovered a new disease. This was the late 1880s when a lot more new diseases were being discovered. He called this new disease Hystero-Epilepsy. As you can tell by the name the disorder was thought to combine some traits of two already discovered mental disorders, hysteria, and epilepsy. Ever since this was first discovered people have been fascinated with what has later become known as Multiple Personality Disorder.

The symptoms when the disease was first discovered were contortions, convulsions, fainting, and impaired consciousness. Charcot was considered the preeminent French psychologist at the time and was able to demonstrate the symptoms in his patients to his staff all around the hospital. Ever since the disease was first discovered we have learned more and more about it and it has developed into being called Multiple Personality Disorder.

Multiple Personality Disorder is being diagnosed more and more as we move forward. As a result of this, more and more students are questioning whether or not the disease actually exists at all. Most of the symptoms found with MPD are found in other diseases that have been known for hundreds of years and they don’t really teach us anything new about mental health.

Not everyone believed Charcot when he first came up with hystero-epilepsy. One of the most noted doubters of Charcot’s initial discovery was actually one of his students, Joseph Babinsky. He felt that Charcot had in fact invented the disease. He said that he demonstrated the symptoms of convincing patients that were actually much more mentally healthy and had only more mild complaints that they had this serious disease. Once he convinced them that they had the disease he would invite them to join his other patients that he said had the disease. Babinski felt that they started having seizures not because they had epilepsy, but because they had been stuck in Charcot’s treatment ward for so long that they were imitating other patients with epilepsy and making it seem like they had hystero-epilepsy.

Babinski eventually proved his point with Charcot. He proved that some patients could be convinced that they had mental diseases that they didn’t have. This was especially true with women that had been under some kind of distress or other mentally vulnerable patients. This led to Babinsky and Charcot working together to develop a treatment program for their patients. Because of Babinsky’s claim, one of the tenants of this treatment procedure isolation to reduce the effect that other patients had the symptoms of other patients in the ward. 

Who is at risk for DID?

Research indicates that the cause of DID is likely a psychological response to interpersonal and environmental stresses, particularly during early childhood years when emotional neglect or abuse may interfere with personality development. As many as 99% of individuals who develop dissociative disorders have recognized personal histories of recurring, overpowering, and often life-threatening disturbances or traumas at a sensitive developmental stage of childhood (usually before age 6).

Dissociation may also happen when there has been persistent neglect or emotional abuse, even when there has been no overt physical or sexual abuse. Findings show that in families where parents are frightening and unpredictable, the children may become dissociative. Studies indicate DID affects about 1% of the population. 

How to recognize dissociative identity disorder and its associated mental disorders

Dissociative identity disorder is characterized by the presence of two or more distinct or split identities or personality states that continually have power over the person's behavior. With dissociative identity disorder, there's also an inability to recall key personal information that is too far-reaching to be explained as mere forgetfulness. With dissociative identity disorder, there are also highly distinct memory variations, which may fluctuate.

Although not everyone experiences DID the same way, for some the "alters" or different identities have their own age, sex, or race. Each has their own postures, gestures, and distinct way of talking. Sometimes the alters are imaginary people; sometimes they are animals. As each personality reveals itself and controls the individuals' behavior and thoughts, it's called "switching." switching can take seconds to minutes to days. Some seek treatment with hypnosis where the person's different "alters" or identities may be very responsive to the therapist's requests. 

How common is (DID)?

Instances of true DID are very rare. When they occur, they can occur at any age. Females are more likely than males to get DID.

Myth: People with DID have multiple personalities.
Fact: Dissociative identity disorder was once known as multiple personality disorder, but the name was changed because experts felt that the term “personality” was misleading. Other terms include “identities,” “alters,” “states of consciousness” and “ego states.”

Myth: Dissociative identity disorder is a rare condition.

Fact: DID is much more common than once thought, affecting 1.5 percent of American adults. 

Myth: The cause of DID is unknown.
Fact: Although it may not be possible to say with certainty why any one person develops DID, it’s thought to generally develop as a response to trauma, particularly in childhood. Dissociating is a way to escape feeling the full extent of a traumatic event and to run away mentally when it isn’t possible to run away physically. It appears that the younger a person is when the trauma occurs; the more likely it is for periods of dissociation to turn into completely dissociated identities.

Myth: DID is always obvious.

Fact:  The presence of dissociative identity disorder isn’t always obvious, either to onlookers or even to people who suffer from the condition themselves. In the beginning, people with DID may simply be aware of lapses in memory. Whether or not they’re aware of their tendency to dissociate, people can often function quite well with their disorder. When a person’s “alters” are fairly similar in the way they present themselves, the condition is harder to detect than when they’re more distinct.

Myth: DID is easily diagnosed.

Fact: Because the presence of DID isn’t always obvious, it can mimic other conditions and can co-occur with other disorders, it often takes time for people to receive the correct diagnosis. According to the Sidran Institute, an organization that deals with traumatic stress, people with DID are in the mental health system for an average of seven years before their condition is diagnosed correctly.

Myth: The likelihood of recovery is low.

Fact: DID doesn’t generally resolve on its own, but Sidran Institute research indicates that when people receive and complete proper treatment, DID may carry a favorable prognosis, when compared to other severe psychiatric disorders.

What causes dissociative identity disorder (DID)?

A history of trauma is a key feature of dissociative identity disorder. About 90% of the cases of DID involve some history of abuse. The trauma often involves severe emotional, physical, and/or sexual abuse. It might also be linked to accidents, natural disasters, and war. An important early loss, such as the loss of a parent or prolonged periods of isolation due to illness, may be a factor in developing DID.

Dissociation is often thought of as a coping mechanism that a person uses to disconnect from a stressful or traumatic situation, or to separate traumatic memories from normal awareness. It is a way for a person to break the connection with the outside world, and create distance from an awareness of what is occurring.

Dissociation can serve as a defense mechanism against the physical and emotional pain of a traumatic or stressful experience. By dissociating painful memories from everyday thought processes, a person can use dissociation to maintain a relatively healthy level of functioning, as though the trauma had not occurred.

Episodes of DID can be triggered by a variety of real and symbolic traumas, including mild events such as being involved in a minor traffic accident, adult illness, or stress. Or a reminder of childhood abuse for a parent may be when their child reaches the same age at which the parent was abused. 

What are the symptoms of DID?

A person with DID has two or more different and distinct personalities, the person’s usual (“core”) personality and what are known as alternate personalities, or “alters.” The person may experience amnesia when an alter takes control over the person’s behavior.

Each alter has distinct individual traits, a personal history, and a way of thinking about and relating to his or her surroundings. An alter may be of a different gender, have a different name, or a distinct set of manners and preferences. (An alter may even have different allergies than the core person.) 

The person with DID may or may not be aware of the other personality states and memories of the times when an alter is dominant. Stress, or even a reminder of a trauma, can trigger a switch of alters.

In some cases, the person with DID may benefit from a particular alter (for example, a shy person may use a more assertive alter to negotiate a contract). More often DID creates a chaotic life and problems in personal and work relationships. For example, a woman with DID may repeatedly meet people who seem to know her but whom she does not recognize or remember ever meeting. Or she may find items around the home that she does not remember buying.

DID shares many psychological symptoms as those found in other mental disorders, including:

- Changing levels of functioning, from highly effective to disturbed/disabled
- Severe headaches or pain in other parts of the body
- Depersonalization (feeling disconnected from one’s own thoughts, feelings, and body)
- Derealization (feeling that the surrounding environment is foreign, odd, or unreal)
- Depression and/or mood swings
- Anxiety
- Eating and sleeping disturbances
- Problems with functioning sexuality
- Substance abuse
- Amnesia (memory loss or feeling a time distortion)
- Hallucinations (false perceptions or sensory experiences, such as hearing voices)
- Self-injurious behaviors such as “cutting”
- Suicide risk — 70% of people with DID have attempted suicide 

How is dissociative identity disorder (DID) diagnosed?

If symptoms are present, an evaluation will be done with a complete medical history and physical examination. Although no laboratory tests can diagnose dissociative disorders medically, various diagnostic tests such as blood tests or imaging (x-rays, ct scans, or mris) may be used to rule out physical illness or medication side effects.

If no physical illness is found, the person might be referred to a mental health professional such as a psychiatrist, psychologist, or psychiatric social worker who is specially trained to diagnose and treat mental illnesses. They will perform a clinical interview to get a full picture of the person’s past experiences and current functioning. Some psychiatrists and psychologists may employ specialized tests (for example, the dissociative experiences scale—des) or a standard interview such as the structured clinical interview for dissociation (scid-d). 

How is dissociative identity disorder (DID) treated?

The goals of treatment for DID are to relieve symptoms, ensure the safety of the individual and those around him or her, and “reconnect” the different personalities into one integrated, well-functioning identity.

Treatment also aims to help the person safely express and process painful memories, develop new coping skills and life skills, restore optimal functioning, and improve relationships. The best treatment approach depends on the individual, the nature of any identifiable triggers, and the severity of the symptoms. Most likely treatment will include some combination of the following methods:

- Psychotherapy: sometimes called “talk therapy,” psychotherapy is the main treatment for dissociative disorders. This is a broad term that includes several forms of therapy.
- Cognitive-behavioral therapy: this form of psychotherapy focuses on changing dysfunctional thinking patterns, feelings, and behaviors.
- Eye movement desensitization and reprocessing (emdr): this technique was designed to treat people with persistent nightmares, flashbacks, and other symptoms of post-traumatic stress disorder (ptsd).
- Dialectic-behavior therapy (dbt): a form of psychotherapy for people with severe personality disturbances, which can include dissociative symptoms that often occur after an experience of abuse or trauma.
- Family therapy: this helps teach the family about the disorder as well as helping family members recognize symptoms of a recurrence.
- Creative therapies (for example art therapy, music therapy): these therapies allow patients to explore and express their thoughts, feelings, and experiences in a safe and creative environment.
- Meditation and relaxation techniques: these help people to better tolerate their dissociative symptoms and become more aware of their internal states.
- Clinical hypnosis: a treatment method that uses intense relaxation, concentration, and focused attention to achieve an altered state of consciousness, allowing people to explore thoughts, feelings, and memories they may have hidden from their conscious minds.
- Medication: there is no medication to treat dissociative disorders themselves. However, people with dissociative disorders, especially those with associated depression and/or anxiety, may benefit from treatment with antidepressant or anti-anxiety medications. 

What is the outlook for people with dissociative identity disorder (DID)?

People with DID generally respond well to treatment. However, treatment can be a long and painstaking process. This usually begins by identifying and empowering all personalities to help integrate them into a full-functioning whole. To improve a person’s outlook, it is important to treat any other problems or complications, such as depression, anxiety, or substance abuse.