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Dissociative Identity Disorder

    Dissociative Identity Disorder

    Dissociative identity disorder (DID), also known as multiple personality disorder is a rare mental disorder in which a person develops multiple distinct identities or selves in a body. It is a psychological condition in which a person called a “host” carries several identities called “alters”, each with their own distinct personalities, memories, thoughts, and actions.

    What Is Dissociative Identity Disorder?

    Dissociative identity disorder (DID) is a very rare but complex mental disorder in which a person develops two or more personality states with their own distinctive identities, memories, thoughts, and behavior patterns. It falls within the spectrum of dissociative disorders and is also known as multiple personality disorder (MPD).

    A 2021 study 1 describes a person with DID as someone who “experiences separate identities that function independently of each other and are autonomous of each other.” The patient’s main personality is called the “ego” or “host” state and the unconscious identities are called “alter” states. These alter personalities can have different histories, names, ages, genders, races, moods, knowledge, and vocabularies. However, these personalities are not fully developed and are fragments of a disconnected personality. It is believed that, in the ego state, the patient is consciously in control of her/his experiences, thoughts, and actions. But she/he lacks a sense of ownership over the alter personalities. In most cases, the alter states function and take control of the ego state—with or without the host’s knowledge.

    Social and environmental stressors 2 can trigger personality switches in a sufferer. When they switch their personality states, there is a noticeable change in the person’s behavior, voice, hand-writing, etc. She/he completely gets detached from the immediate environment and time and experiences changes in mood, lifestyle, thoughts, and actions. She/he experiences hallucinations and memory loss and feels like she/he is living in a dream-like sequence or out-of-body reality.

    Most of the time, DID is often accompanied by other mental disorders, such as post-traumatic stress disorder, personality disorders (especially borderline and avoidant), depression, sleep disorders, etc.

    Read More About Major Depressive Disorder (Depression) Here

    Dealing With Dissociative Identity Disorder

    How is Dissociative Identity Disorder viewed in different cultures
    Dissociative Identity Disorder

    Research shows that dissociative identity disorder has roots in experiences of childhood abuse and trauma. Most scholars consider it to be a dysfunctional coping mechanism 3 in which a DID patient devises certain people or realities in her/his mind to survive negative experiences and environments. In some countries, it is often associated with terms such as “outer world possession” and “possession by demons”. Even psychiatric literature fails to agree when it comes to understanding dissociative identity disorder.

    Dissociative identity disorder affects only about 1.5% of the global population, with patients never fully recovering 4 in their lifetime. This condition has life-long symptoms and its patients require continuous reality-based and grounding interventions, supportive care, and safety planning.

    Treatment methods 5 for DID tends to be lengthy and expensive and this affects its prognosis rates. For instance, a 2008 study 6 shows that short-term outcomes of DID is high, around 44–97%, but the rates are rather unfavorable in middle-term or long-term outcomes.

    Types Of Dissociative Identity Disorder

    Dissociative identity disorder is often considered a spectrum disorder with multiple subtypes that can also be standalone disorders in their own right. For clinical purposes, researchers identify its 3 main subtypes, with other dissociative disorders existing in varying degrees. These include:

    1. Dissociative Amnesia

    Dissociative amnesia is caused by the impairment of a person’s autobiographical memory, because of which she/he cannot remember important information about her/his identity or life.

    2. Dissociative Fugue

    According to a 2013 study 7, “Dissociative fugue is a psychiatric disorder characterized by amnesia coupled with sudden unexpected travel away from the individual’s usual surroundings.” As the person wanders, she/he is in denial of all memory.

    A dissociative fugue usually lasts for a long period of time and exists with several other mental disorders, such as depressive disorders, bipolar disorders, panic disorders, eating disorders, etc.

    3. Depersonalisation And Derealization Syndrome

    Depersonalization and derealization (DPDR) syndrome, as one 2004 study 8 puts it, is “characterized by prominent depersonalization and often derealisation, without clinically notable memory or identity disturbances”.

    People suffering from this disorder often feel that they are not real 9 and are existing in a dream or seeing themselves from outside their bodies. The course of the disorder is usually long and continuous.

    4. Other Dissociative Disorders

    One 2014 study 10 sees DID as a spectrum with many other dissociative disorders, such as:

    • Dissociative stupor
    • Dissociative disorders of movement and sensation
    • Dissociative motor disorders
    • Dissociative convulsions
    • Dissociative anesthesia and sensory loss

    Signs And Symptoms Of Dissociative Identity Disorder

    Symptoms of Dissociative Identity Disorder
    Dissociative Identity Disorder

    Dissociative identity disorder is a somewhat misunderstood disorder, with ongoing research trying to decipher its true nature. Despite being acknowledged as far back as the 1880s, experts are yet to attribute it to a concrete definition or specific medical parameters.

    But, the Diagnostic and Statistical Manual of Mental Disorders (DSM-5) has given us a rough framework of dissociative identity symptoms. These include:

    1. Amnesia

    People suffering from DID often feel detached from their immediate surroundings. Studies show that DID causes gaps in memory about a person’s sense of self, consciousness, and passage of time-related to:

    • Everyday events
    • Personal information
    • Past events
    • Traumatic experiences, etc.

    2. Multiple Personalities

    DID causes loss of self-identity and compartmentalization of a person’s memory—resulting in “the presence of two or more distinct personality states”.

    But, researchers are still unsure about the number of alter personalities a DID patient can have. According to a 2012 study 11, people with DID can have 10–100 personalities, with even 4500 alter identities being reported in the most severe cases.

    3. Cognitive Impairment

    People suffering from DID usually experience hallucinations and other “extrasensory experiences” like living in a dream, hearing voices, periods of extreme emotions, etc.

    They also suffer from cognitive malfunctioning and behavioral and mental disorders, such as:

    • Self-harm
    • Suicide ideation
    • Somatization
    • Psychosis
    • Sexual dysfunction
    • Dissociation
    • Mood changes
    • Agitation
    • Irrationality
    • Insomnia
    • Different handwriting
    • Frequent changes in voice
    • Inconsistent work history, etc.

    Read More About Insomnia Here

    4. Inability To Cope With Stress

    DID is sometimes considered 12 a chronic post-traumatic disorder, because of which its patients find it difficult to deal with stressful situations, such as emotional or professional stress.

    Read More About Stress Here

    What Causes Dissociative Identity Disorder?

    Causes of Dissociative Identity Disorder
    Dissociative Identity Disorder

    DID is a controversial disorder, because of which its diagnosis and treatment have been revised 13 several times by psychiatric manuals like DSM-5 and ICD-11. However, over the years, psychiatrists and other medical practitioners have tried to identify some of the basic dissociative identity disorder causes, such as:

    1. Trauma

    The post-traumatic model (PTM) considers DID to be an extreme coping mechanism for traumatic experiences, because other normally adaptive systems have failed. This “self-soothing” strategy comes with predisposing factors such as the ability “to dissociate, overwhelming traumatic experiences that distort reality, [the ability to create] alters with specific names and identities, and lack of external stability”.

    Such experiences include:

    • Physical, emotional, or sexual abuse
    • Loss of a loved one
    • Prolonged illness
    • Childhood abuse and neglect
    • Experiences of child trafficking and prostitution
    • War
    • Terrorism

    2. Neuroanatomy

    A 2020 study 14 suggests that DID is caused by structural changes in the brain, specifically in the hippocampus, amygdala, white matter tracts, and other parts of the brain associated with:

    • Neurotic behavior
    • Dissociation
    • Body movements
    • Learning from fear, etc.

    Read More About Fear Here

    3. Proneness To Fantasy

    According to one 2021 study, the fantasy-related model proposes that people who are imaginative and fantasy-prone are more vulnerable to DID. They are usually the ones with:

    • High levels of vulnerability
    • Predisposition of psychological symptoms
    • Media portrayals of certain ideas
    • Social isolation

    4. Mental Disorders

    People are more vulnerable to DID if they have mental disorders that cause behavioral changes, like:

    • Borderline personality disorder 15, 6(3), 24–29. ))
    • Post traumatic stress disorder (PTSD)
    • Bipolar disorders 16
    • Schizoaffective disorders 17

    Read More About Post-Traumatic Stress Disorder (PTSD) Here

    5. Therapy-Induced Causes

    An extension of the fantasy-related model, the socio-cognitive model (SCM) 18 states that therapists accidentally create DID symptoms in people, using psychotherapy techniques. People with certain traits (like fantasization or suggestibility) then, consciously or unconsciously, adopt behaviors or additional identities promoted by cultural stereotypes portrayed in the media.

    However, as a 1996 study 19 puts it, “Treatment recommendations [of DID] that follow from the sociocognitive model may be harmful because they involve ignoring the posttraumatic symptomatology of persons with DID.”

    6. Environmental Causes

    Studies 20 show that DID can also be caused by a number of factors, such as:

    • Stressful lifestyle
    • Lack of sleep
    • Unable to adjust to family settings
    • Attachment issues
    • Rigid parenting styles

    How Is Dissociative Identity Disorder Diagnosed?

    Even after decades of research and practice in clinical setups, DID still remains to be understood. Medical literature has elaborately described the early signs of dissociative identity disorder, but most of the time, it is “misdiagnosed and often requires multiple assessments for an accurate diagnosis.”

    The dissociative identity disorder diagnosis consists of the following phases:

    1. Physical Examination

    In this phase, to determine if any physical injury is causing DID-like symptoms, the patient undergoes several examinations of his/her physical health like:

    • Electroencephalograms
    • Lumbar punctures
    • Brain imaging

    If physical health conditions are ruled out, the patient is referred to a mental health practitioner for a diagnosis.

    2. Psychiatric Examination

    While diagnosing DID, medical practitioners review patient’s individual symptoms and personal histories often related to trauma experiences, social setting, lifestyle, and health conditions. They also take into account collateral histories and the acquired information is verified by several physical examinations and psychiatric scales.

    They then tally the person’s conditions with the criteria for dissociative identity disorder diagnosis outlined in DSM-5. For a person to be diagnosed, she/he must:

    • Have two or more distinct personality states
    • Have an experience of amnesia about personal information, self-identity, etc.
    • Have trouble functioning in personal, social, or occupational areas in life
    • Not face disturbances created by cultural or religious practices
    • Not have physiological symptoms from other health conditions like alcoholism, substance abuse, blackouts, seizures, etc.

    Psychiatrists often use diagnostic scales to ensure the severity of the DID symptoms in a patient and for differential diagnosis from other disorders with similar symptoms of dissociation. These include:

    • Dissociative Experiences Scale (DES) 21
    • Dissociation Questionnaire
    • Structured Clinical Interview for DSM Disorders (SCID)
    • Structured Interview for DSM-III-R Personality Disorders (SIDP-R)
    • Dissociative Disorder Interview Schedule (DDIS)
    • Shipley Institute of Living Scales Tellegen Absorption Scale
    • Rorschach test 22

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    How Can Dissociative Identity Disorder Be Treated?

    According to a 2021 study, the treatment plan for dissociative identity disorder usually follows a three-pronged approach.

    • In the first step, the doctors should assess the risk the patient poses to himself/herself, such as contemplating suicide or self-harm. Such symptoms are addressed with interventions and medicines.
    • In the second step, using therapy, they should focus on the trauma-induced mindset of the patient, including “tolerating, processing, and integrating past trauma”. They can access and modify the traumatic memories of alternate personalities and allow the patient to reassess personal experiences and their impact on his/her life.
    • In the third step of dissociative identity disorder treatment, the doctors help the patient reassess his/her relationship with oneself and the rest of the world.

    Read More About Self-Harm Here

    The following therapies and medications are used to treat people with DID:

    1. Therapies

    Dissociative identity disorder do not have specific therapeutic treatment, but people with DID can avail the large number of therapies that are already available to treat cognitive disorders, such as:

    1. Psychotherapy

    The cornerstone of DID therapies, psychotherapy helps to address “the patient’s unconscious conflicts which may be a cause of maladaptive functioning”.

    In most cases, other forms 23 of psychotherapy (such as cognitive behavioral therapy [CBT], dialectical behavioral therapy [DBT], or hypnotherapy) are used “to reduce dissociation and integrate the functioning of the mind” of the DID patient. These also treat the symptoms of other comorbidities existing with DID, such as anxiety, depression, etc. But, the effectiveness of psychotherapies in treatment for dissociative identity disorder remains contested.

    Read More About Cognitive Behavioral Therapy (CBT) Here

    2. Eye Movement Desensitization And Reprocessing (EMDR)

    Studies 24 show that EMDR, though prescribed for treatment of general trauma and stress disorders, worsens 25 dissociative identity disorder symptoms. But it can be used in adjunctive treatment or integrative treatment. A 2021 study actually recommends EMDR processing to recovered patients who are “generally stable and [have] adequate coping skills”.

    3. Schema Therapy

    Schema therapy [ST] is used to resolve attachment-related dysfunction 26 in DID patients in phases, by “blending traditional cognitive-behavioral treatment with experiential and interpersonal elements”. ST is thought to be cost-effective and more successful in treating severe DID cases.

    4. Phase-Oriented Trauma Treatment (POTT)

    According to a 2020 study 27, POTT treats people with dissociative identity disorder in different stages:

    • Therapeutic alliance building and symptom stabilization
    • Formation of a narrative about the trauma
    • Re-creation of the meaning of life after trauma
    • Future symptom management

    Research 28 shows that POTT boosts mindfulness and positive feelings like love, kindness, etc. in patients availing treatment.

    5. Group Therapy

    Research shows that patients with DID often find it difficult to participate in generic group therapies and develop more severe symptoms. But, one 2020 study suggests that “select groups focused on psycho-education, problem solving and specific skills development can be a valuable adjunct to individual psychotherapy” for treating dissociative identity disorders.

    Read More About Group Therapy Here

    2. Medication

    There are no prescribed medications for dissociative identity disorder treatment, because of which medicines for treating similar symptoms 29 in other disorders (such as hyperarousal, mood changes, nightmares, etc.) are also used for DID, such as:

    • Antidepressants/anxiolytics (such as selective serotonin reuptake inhibitors, nonselective reuptake inhibitors, tricyclic antidepressants, monoamine oxidase inhibitors, etc.)
    • Benzodiazepines
    • Clonidine
    • Atypical (second generation) antipsychotics
    • Prazosin
    • Carbamazepine and other mood stabilizers
    • Naltrexone

    Takeaway

    Dissociative identity disorder (DID) is a rare and complex disorder, which remains misunderstood and under-diagnosed most of the time. If untreated, it interferes with a person’s quality of life and personal and professional reputations. However, it can be effectively managed by timely diagnosis, therapy, medication, and psychoeducation.

    Dissociative Identity Disorder At A Glance

    1. In dissociative identity disorder (DID), a person develops several personality states with their own distinctive identities, thoughts, and actions.
    2. It is a rare and complex psychiatric disorder.
    3. It causes chronic memory loss, hallucinations, and behavioral changes.
    4. DID has its origins in childhood abuse and trauma.
    5. DID is often misdiagnosed, remaining untreated for life.
    6. Patients with DID cannot be completely cured.
    7. But, they can effectively manage to live a normal life with therapy, medication, and psychoeducation.

    Frequently Asked Questions (FAQs)

    1. Who are some famous people with Dissociative Identity Disorder?

    Britney Spears, Nikki Minaj, Marilyn Monroe, Mel Gibson, Truddi Chase, Roseanne Barr, and Hershel Walker are some famous public figures with dissociative identity disorder.

    2. Are there ways to make living with DID easier?

    Living with dissociative identity disorder is manageable if you seek medical help for your mental condition. Self-help strategies, like educating yourself about the disorder, organizing a healthy schedule and an emergency plan, and communicating openly with your support system also make living with DID easier.

    3. When should I call my doctor about DID?

    If you experience chronic forgetfulness about yourself and your immediate environment (like forgetting your name, identity, or specific life events) without the use of alcohol or drugs, then you may have dissociative identity disorder symptoms. At this point, please consult your doctor.

    4. Can people with dissociative identity disorder have different memories?

    People with DID do not have different memories. DID causes compartmentalization of a person’s memory and splits his/her main ‘ego’ into multiple ‘alter’ personalities with their own thoughts and actions. But, all the personalities share one single memory. When a person switches personalities, he/she simply suffers from gaps in memory.

    5. How can you help someone with dissociative identity disorder?

    Educate yourself about the basics of dissociative identity disorder and learn to recognize and avoid the triggers. Do not be afraid if you see him/her switching personalities, and try to be patient and empathetic. Try to calmingly talk him/her into seeking medical help.

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