Dissassociative Identity Disorder

1. Dissassociative Identity Disorder Sandra Rupnarain

2. Definition of Disassociative Identity Disorder - DSM • Dissassociative Identity Disorder), is a mental condition whereby a single individual evidences two or more distinct identities or personalities, each with its own pattern of perceiving and interacting with the environment. • The diagnosis requires that at least two personalities routinely take control of the individual's behavior and that there is associated memory loss that goes beyond normal forgetfulness, often referred to as losing time or acute Dissassociative Amnesia. • The symptoms of DID must not be the direct result of substance abuse or a more general medical condition in order to be diagnosed.

3. What Is Disassociative Identity Disorder? • (DID) is a severe disorder that involves a disturbance in both memory and identity of an individual. • The individual uses defense mechanisms involving splitting, idealization, devaluation, denial and/or taking on the personality of another in order to cope with trauma experienced in childhood • Identity disturbance in seen in two or more separate and distinct personality states which can control the individual's behavior at different times. The different identities, (alters) may exhibit differences in speech, mannerisms, attitudes, thoughts, and gender orientation. The alters may even differ in "physical" properties such as allergies, right-or-left handedness, or the need for eyeglass prescriptions • When under the control of one identity, the person is usually unable to remember some of the events that occurred while other personalities were in control. . .

4. Some Facts • DID was originally named Multiple Personality Disorder (MPD) • 9 times more women than men receive therapy for DID • 97% of the individuals with DID have been physically and/or sexually abused. • As a diagnosis, DID remains controversial. For many years DID was regarded as a North American phenomenon with the bulk of the literature still arising there. • The person with DID may have as few as two alters, or as many as 100. The average number is about 10. Often alters are stable over time, continuing to play specific roles in the person's life for years. Some alters may harbor aggressive tendencies, directed toward individuals in the person's environment, or toward other alters within the person. • At the time a person with DID first seeks professional help, he or she is usually not aware of the condition. A very common complaint in people with DID is episodes of amnesia, or time loss. These individuals may be unable to remember events in all or part of a proceeding time period. They may repeatedly encounter unfamiliar people who claim to know them, find themselves somewhere without knowing how they got there, or find items that they don't remember purchasing among their possessions.

5. What it is • DID was originally named Multiple Personality Disorder (MPD), • Is not an equivalent for schizophrenia (DSM-IV Schizophrenia and Other Psychotic Disorders), as is a common misconception. • Dissociation is a demonstrated symptom of several psychiatric disorders, such as Borderline Personality Disorder (DSM-IV Personality Disorders 301.83), Post-traumatic stress disorder (DSM-IV Anxiety Disorders 309.81[2]), and Complex Post Traumatic Stress Disorder, to name a few.

6. What Causes Disassociative Identity Disorder? • Multiple personalities are formed through dissociation, which occurs when an individual splits with their primary personality (also known as the "host" personality) and develops a secondary personality in their subconscious. • This dissociative splitting of the self into two or more personalities usually occurs in childhood due to extreme physical, sexual and/or psychological abuse. • In most cases the existence of DID represents an attempt by the child to deal with overwhelmingly negative events in their life. The ongoing abuse experienced by the child somehow increases their capacity to detach themselves, compartmentalizing life’s trauma into autonomous units rather than a blended whole. • When a particularly abusive experience becomes unbearable the highly hypnotizable child simply exercises their capacity for self-hypnosis, to go to sleep, as it were, and allow another person to emerge who can handle the situation better. • In many ways the altered personality of abused children resemble the imaginary friends that "normal" children describe—externalized versions of cartoon figures, superheroes or animals; however, what begins as a protective fantasy is kept within until the individual with DID becomes that character

7. What Are The Symptoms? Most people with DID start to show signs in their 20’s and 30’s. They often exhibit a wide array of symptoms that can resemble other neurological and psychiatric disorders, such as anxiety disorders, schizophrenic disorders, mood psychosis and seizure disorders. Symptoms of this particular disorder can include: • An inability to maintain stable relationships • Physically damaging acts such as cutting oneself and episodes of self-injury • Physical symptoms (severe headaches or other bodily pain) • Fluctuating levels of function, from highly effective to disabled • Time distortions, time lapse, and Dissociative Amnesia • Sexual dysfunction • Eating disorders • Post traumatic stress

8. What Are The Symptoms? Suicidal preoccupations and attempts Psychoactive substance use/abuse[ Nightmares Auditory or visual hallucinations Sense that one’s body is being transformed or changed Feeling like one is in a daze—going into a trance Feelings of confusion and/or disorientation Feeling one’s thoughts are out of control Vocalizing words one did not think or utter Difficulty understanding others Depression Severe anxiety attacks and/or numerous phobias Due to the various debilitating symptoms, the "host" personality gets to a point where they feel they need to get some kind of help.

9. Symptoms There are three factors which determine if a person has DID Two or more personalities exist within the individual – each is dominant at certain • The dominant personality determines the individual’s behaviour. • Each individual personality is complex and integrated with its own unique behaviour patterns and social relationships. • Other symptoms may include: • Depersonalization, which refers to feeling unreal, removed from one's self, and detached from one's physical and mental processes. The person feels like an observer of his/her life and may actually see him/herself as if he/she were watching a movie. • Derealization refers to experiencing familiar persons and surroundings as if they were unfamiliar and strange or unreal.

10. Symptoms • Someone does not have DID simply because they exhibit some or all of these symptoms. For example, someone may have severe PTSD and self-mutilate with suicidal ideas, which are two of the symptoms listed above, but in order for DID to be diagnosed, there must be two or more distinctly present personalities. • Persons with dissociative identity disorder are often told of things they have done but do not remember and of notable changes in their behavior. They may discover objects, productions, or handwriting that they cannot account for or recognize; they may refer to themselves in the first person plural (we) or in the third person (he, she, they); and they may have amnesia for events that occurred between their mid-childhood and early adolescence. • Amnesia for earlier events is normal and widespread.

11. Complications People with a dissassociative disorder are at increased risk of complications that include: • Self-mutilation • Suicide attempts • Sexual dysfunction, including sexual addiction or avoidance • Alcoholism and substance abuse • Depression • Sleep disorders, including nightmares, insomnia and sleepwalking • Anxiety disorders • Eating disorders • Severe headaches • Dissassociative disorders are also associated with significant difficulties in relationships and at work. People with these conditions often aren't able to cope well with emotional or professional stress, and their dissassociative reactions — from tuning out to disappearing — may distress loved ones and cause colleagues to view them as unreliable

12. Identifying & Diagnosing • Despite the complexity and severity of DID, identifying and diagnosing it is the most difficult obstacle to recovery. • It is common for people seeking treatment for their confusion and amnesia to be treated for secondary symptoms like depression and anxiety before a proper diagnosis is made. • Once the individual with DID is teamed with a specialist who employs special therapeutic techniques, about 80% of the people with DID recover. • The process of therapy for adults is long and difficult, often taking 3 - 5 years.

13. Treatment & Management • The most common approach to treatment aims to relieve symptoms, to ensure the safety of the individual, and to reconnect the different identities into one well-functioning identity. This is called reintegration. • The process usually consists of the therapist guiding the client as the he/she relives, in the character of each of the personalities, the significant traumatic events in his or her life. • The therapist helps the individual integrate all their memories into a gradually developing central consciousness. The individual does not lose the other personalities, rather they become part of the whole person. Once the individual begins to remember and deal with their history, they no longer need the alternate personality

14. Treatment & Management • Other equally respected treatment modalities that do not depend upon integrating the separate identities includes: • Treatment that aims to help the person safely express and process painful memories, develop new coping and life skills, restore functioning, and improve relationships. • The best treatment approach depends on the individual and the severity of his or her symptoms. Treatment is likely to include some combination of the following methods:

15. Types of Treatment Psychotherapy is the primary treatment for DID. Psychotherapy is designed to encourage communication of conflicts and insight into problems and may include: • Cognitive therapy: This type of therapy focuses on changing dysfunctional thinking patterns. • Medication: There is no medication to treat DID however, a person with DID also suffers from depression or anxiety might benefit from treatment with a medication such as an antidepressant or anti-anxiety medicine. • Family therapy: This kind of therapy helps to educate the family about the disorder and its causes, as well as to help family members recognize symptoms of recurrence.

16. Treatment/Management • Expressive therapysuch as art therapy, dance/movement therapy and music therapy: These therapies allow the patient to explore and express his/her thoughts and feelings in a safe and creative way. • Clinical hypnosis: This is a treatment technique that uses intense relaxation, concentration and focused attention to achieve an altered state of consciousness or awareness. • Ego-state therapy: Ego-state therapy is used to help non-dissociative individuals resolve conflicts among different parts of themselves (i.e. ego states); since DID is an extreme differentiation among ego states, many therapists find the approach useful in working with dissociative clients

17. Treatment/Management • Behavior therapy: As an increasing number of therapists view DID as iatrogenic, or caused by reinforcing treatment teams, new approaches have emerged. Current standards of care may involve requiring the patient respond to a single name, and refusing to speak with the patient if she or he is a different sex, age, or person than initially presented. • As the patient begins to respond more consistently to a single name, and speak in the first person, more traditional therapy for trauma may begin. • Though some dislike this approach or criticize it as disrespectful of the client, it is highly effective, and many published accounts confirm this approach. Kohlenberg & Tsai's "Functional Analytic Psychotherapy" (1991)