Dissociative Identity Disorder
What is Dissociative Identity Disorder?
Dissociative Identity Disorder (DID), formerly known as Multiple Personality Disorder, is a complex mental health condition characterized by the presence of two or more distinct identities or personality states within an individual.
Symptoms of DID
Identity Disturbances: Presence of two or more distinct identities or personality states within an individual.
Amnesia: Recurrent gaps in memory where the person cannot recall personal information or events.
Altered Perceptions of Self and World: Having a sense of detachment from one’s thoughts, feelings, or body and/or having the perception of the world may change during different identity states.
Internal Voices or Dialogues: Hearing internal voices or experiencing dialogues between different identity states.
Depersonalization and Derealization: Episodes of feeling disconnected from one’s body (depersonalization) or the surrounding environment (derealization).
Mood Swings and Emotional Dysregulation: Fluctuations in mood and emotions, ranging from depression to anxiety or anger.
Self-Harm and Suicidal Thoughts: Individuals with DID may engage in self-harming behaviors and may experience suicidal thoughts.
Co-consciousness and Coordinated Behavior: Varying degrees of awareness and coordination among different identity states.
What Causes This Disorder to Form?
Severe Trauma and Childhood Abuse: One of the primary factors linked to the emergence of DID is severe trauma, particularly during childhood. Prolonged exposure to emotional, physical, or sexual abuse can overwhelm a child’s coping mechanisms, leading to the dissociation of identity as a protective response. The trauma typically occurs at a young age, when the mind is still developing, making it more susceptible to fragmentation.
Disrupted Attachment and Early Interpersonal Relationships: Issues with early attachment and disrupted interpersonal relationships may contribute to the development of DID. A lack of consistent and nurturing caregivers can impact a child’s ability to form a cohesive sense of self. This disruption in attachment may exacerbate vulnerability to dissociative experiences as a means of navigating challenging emotional terrain.
Neurobiological Factors: Research suggests that neurobiological factors play a role in the development of DID. Changes in brain function, particularly in regions associated with memory and identity, have been observed in individuals with the disorder. The exact nature of these changes and their relationship to trauma-induced dissociation is an area of ongoing study.
Coping Mechanisms and Adaptive Responses: DID is considered a coping mechanism developed in response to overwhelming stress. Individuals may unconsciously create alternate identities to compartmentalize traumatic experiences, allowing them to function in everyday life. These identities serve as adaptive responses to manage distress and maintain a semblance of control.
Prevalence
Dissociative disorders show a prevalence of 1% to 5% in the international population. Severe dissociative identity disorder is present in 1% to 1.5% of this population. Patients may spend between 5 to 12.5 years in treatment before being diagnosed with dissociative identity disorder. DID is more commonly found in women, presenting at rates almost double that of men.
Treatment
Psychotherapy: Psychotherapy is the cornerstone of DID treatment, with a focus on creating a therapeutic alliance and a safe environment. Various therapeutic modalities are employed, including:
– Cognitive-Behavioural Therapy (CBT): Targeting negative thought patterns and behaviors.
– Dialectical Behaviour Therapy (DBT): Emphasizing emotional regulation and interpersonal skills.
– Eye Movement Desensitization and Reprocessing (EMDR): Addressing trauma-related memories.
– Clinical Hypnosis: In conjunction with traditional talk therapy, addressing trauma-related memories.
Internal Communication and Cooperation: Therapists work towards fostering communication and cooperation among different identity states. Techniques like journaling, internal dialogues, and structured meetings between identities contribute to increased co-consciousness.
Medication Management: While medications do not treat DID directly, they may be prescribed to manage co-occurring symptoms such as depression, anxiety, or mood swings. Collaboration between mental health professionals is crucial to monitor and adjust medications as needed.
Art and Expressive Therapies: Art and expressive therapies provide alternative avenues for communication and expression. Creative modalities like art, music, and movement therapy offer non-verbal outlets for individuals with DID to process emotions and experiences.
Supportive Interventions: Building a strong support network is integral to DID treatment. Involving family and friends, along with educational programs for loved ones, helps create an understanding and supportive environment.
History
The recognition of DID can be traced back to the late 19th century. Early clinicians, including Pierre Janet and William James, documented cases of what they termed “double consciousness” and “dual identity.” These observations laid the groundwork for later developments in understanding dissociation. Before this, DID was considered a form of possession and often was treated with cultural and religious means.
In the early 20th century, the condition gained more attention with the publication of case studies and clinical reports. The term “Multiple Personality Disorder” (MPD) was coined to describe the phenomenon of individuals displaying distinct identities or personalities.
The diagnostic landscape underwent significant changes, and in 1980, the American Psychiatric Association (APA) officially recognized MPD in the third edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-III). The subsequent editions, including DSM-IV and DSM-5, retained the disorder but changed its name to Dissociative Identity Disorder (DID) to better reflect the nature of the condition.
DID became a subject of controversy in the late 20th century, with debates surrounding the authenticity of the disorder. Media portrayals and sensationalized stories further fueled skepticism. Clinicians and researchers worked to distinguish legitimate cases from cultural influences.
The late 20th century witnessed a paradigm shift in conceptualizing DID, emphasizing its connection to severe trauma, especially during childhood. This trauma-focused perspective, supported by research, highlighted the role of dissociation as a coping mechanism in response to overwhelming experiences.
Personal Experience with the Diagnosis and Treatment of DID
Healthcare systems worldwide would rather diagnose you with anything but DID. Often times, people are diagnosed with CPTSD and left to their own devices on dealing with any dissociative disorders that come of the long term trauma they faced. In my personal struggle with psychiatrists and psychologists, they are undertrained, many stating “I’m not really qualified to diagnose you with this, I don’t know anything about it.” It seems to be a very unconcerning state, being one of the most tame psychological outcomes for long term trauma. Not many people with DID present as harmful to others, making it a non-factor when it comes to how much health car practitioners care about it. This is an unfortunate reality, given those with long term complex trauma can absolutely benefit from identifying and working with this disorder.
We were lost for years, battling severe panic attacks, short and long term memory loss, and depersonalization and derealization that we just assumed was a normal occurrence among those with long term trauma. We had very little idea as to why people considered us to have “mood swings” or why people were able to identify these things, and we could not. It is often not apparent to people with DID that they have “changed” at all, since each memory tends to be linear prior to open internal communications. It just feels like memory loss to each individual, and no one is aware there is a larger whole. It was only when we accepted the disorder and really began working toward cohesive communication, both in and out of therapy, that we were able to finally get a handle on living and functioning in a way that wasn’t self-harmful. We are thankful for the ability to recognize and work with one another within our system. We wholeheartedly believe that this was the best outcome to manage our long term trauma, the compartmentalizing of each type and instance of trauma into a certain linear memory, allowing each person inside of us to bear an unimaginable weight, weights which combined would crush a single psyche. Instead of going mad, we got creative, and delegated those traumas to others inside of us, allowing each individual that we universe built from the ground up to manage the traumas apart from one another, saving us from eventual madness.
In a way, I’m thankful to have been creative enough to form this disorder. I feel it is far better than the other routes that long term trauma often takes, leading to more violent and harmful disorders. I feel at peace with who we are now, and no longer afraid of my future in regards to this disorder. — EJK
Sources:
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