1 August 2018
Dissociative Identity Disorder
One second you’re an angry dominator, the next you’re an innocent five-year-old girl. You want to protect your peers then you want to sleep with them all. You are quick to anger then you are patient with your responses. One minute you react rationally, the next you are unreasonable with your behavior. You contain multiple alters inside your one body that you cannot control. You are at a constant battle with yourself between different alters that seem to have their own mind. It is almost as if you are a variety of different people rolled up into a burrito (Allers, C.T., & Golson, J., 1994). There is a lot of question as to why these things occur and as to why you are unable to control these alters from taking over. Some professionals believe that this is all in response to a traumatic life event that you survived as a child, often times sexual abuse. It is a reaction to cope with the traumatic events that one has suffered through (Dunn, G. E., 1992). In these times, you are dissociated with reality and have little to no idea what is occurring.
Dissociation is used to take feelings, thoughts and perceptions and disconnect them from the event that traumatized you. They are all stored separate from each other and this is when Dissociative Identity Disorder develops. When this disorder surfaces, the memories are stored individually as altered states and are experienced as different identities that usually have different names, genders, ages and experiences (Aquarone, R., Goodwin, M., & Richardson, S., 2017). The different alters vary in several different aspects. They tend to have differences in problem solving abilities, ways of communication, interpersonal roles, responses, involvement, control of behavior and levels of employment (Allers, C.T., & Golson, J., 1994). Alter identities might also vary in things such as handwriting, sexual orientation, eyesight, foreign languages that they are able to speak, and even likes and dislikes (Hooley, J. M., Butcher, J. N., Nock, M., & Mineka, S. (2017).
Individuals who have been abused use this as a coping method to continue through life without the constant intrusion of the memory of the traumatic events that they went through earlier on in their life. When this occurs, it becomes normal for the brain to separate the disturbing life events with current life events. The brain suppresses the horrifying memories, so the individual is not tormented with the reliving of the experiences. When this disorder progresses, the sympathetic system is overdeveloped and constantly stimulated, and the parasympathetic system is underdeveloped and slow to react (Aquarone, R., Goodwin, M., & Richardson, S., 2017).
Dissociative Identity Disorder was formally known as multiple personality disorder. Just recently, within the past ten years, awareness for this disorder has been on the rise (Chu, J. A., 1994). Prior to the DSM-5, there were only two criteria required for diagnosis. The first part was that there had to be two or more distinct personalities that had its own pattern of thinking that was not connected to the other alter. The second part of diagnosis was that at least two of the personalities had to have taken complete control over the individual and controlled their conduct (Aquarone, R., Goodwin, M., & Richardson, S., 2017). The problem with this way of analysis was that it often times led to misdiagnosis because the individual might show a number of symptoms without the actual condition being present. The presence of these symptoms could be due to many other disorders or even just responses to other life events (Aquarone, R., Goodwin, M., & Richardson, S., 2017).
In 2013, the criteria was reformed for the publication of the DSM -. This alteration provided criteria to more accurately diagnose dissociative identity disorder. Instead of only two criteria necessary for a diagnosis, there are now five (Fox, J. j., Bell, H., Jacobson, L., & Hundley, G., 2013). For diagnosis, according to the DSM-5, the following criteria are needed: a noticeable disruption in the sense of self and alterations in behaviors, memories and/or functioning, an excess loss of memory, noteworthy distress in essential environments such as occupational or social. Two other criteria for diagnosis include that the symptoms cannot be related to psychoactive drugs or preexisting medical conditions and also not related to religious or cultural practice to be considered for a diagnosis (Fox, J. j., Bell, H., Jacobson, L., & Hundley, G., 2013). This means that if an individual has taken a psychoactive drug and is experiencing symptoms that are often times related to dissociative identity disorder, they cannot be diagnosed. Also, if an individual has already been diagnosed with another medical condition and a symptom is related to that particular condition, they cannot be diagnosed with DID because they are experiencing those symptoms.
There are two theories for the etiology of the disorder. They are quiet opposite and professionals are typically all about one or all about the other- not in between or unsure which one they support. Some professionals believe the causes of this disorder are related to trauma experienced in childhood, particularly sexual abuse (Allers, C.T., & Golson, J., 1994). The researchers that do not believe it is related to sexual abuse, believe that is a made-up disorder and diagnosed artificially. Even though you can find this disorder in the DSM-5, some people are still very skeptical of its existence (Dunn, G. E., 1992).
It is theorized that the disorder develops in stages. The first stage is a child is traumatized and the disturbed child has an increased ability to enter a self-hypnotic state which leads to dissociation and an alteration of one’s self. The individual uses this as an escape mechanism from the memories of the trauma that they experienced. It is common for victims to reexperience the event. It is often times reexperienced through flashbacks, nightmares, somatic sensations and it often times leads to instability episodes. Being able to enter a self-hypnotic state gets them out of the reexperiencing attack. It allows for a getaway providing relief for the individual (Chu, J. A., 1994). The second stage of development is the child struggles to deal with less stressful situations with simple coping skills. They find themselves struggling to deal with stress and overreacting to simple situations. It is difficult for them to face every day stressors that occur in life and they find it difficult to calm down once overly worked up. Third, the child exhibits the ability to splinter their personality into different alters. In this stage of development, the individual finds themselves being able to disrupt the whole being of their personality. They are able to form different memories with different identities and they discover different perceptions and controlling alters. The episodes linger and the ability to successfully use coping strategies continue to deteriorate leading to separate and disconnect personalities. The memoires are separated by amnesic barriers to keep them all independent. This means that the individual cannot remember things that are associated with different alters. They cannot connect the memories that are formed between the different personalities and understand what is occurring (Allers, C.T., ; Golson, J., 1994).
Dissociative Identity Disorder is found in only about 0.1% of the US population and less than 10% of the world population (Allers, C.T., ; Golson, J., 1994). Treatment of DIDD can be difficult. The first and most important step for successful treatment is trust between the patient and the clinician. Patients find trust difficult to find because of the trauma that was experienced in their life and due to the fear of their own disorder. It is imperative that the therapist starts with a strong relationship with the main host as a foundation before attempting other therapy techniques. This can be difficult because the host identity is usually not the original identity or the identity that is best adjusted (Hooley, J. M., Butcher, J. N., Nock, M., ; Mineka, S. (2017). It is later important to build a similar relationship with each of the alters inside the individual. The patient needs therapist respect, encouragement and support. A second important aspect of treatment is education. The client needs to be educated on the background and function of the disorder that they are struggling with. A background knowledge will help the individual eliminate unwanted switching and help regulate control-seeking alters. Educating clients on their disorder and how to maintain control creates coconsciousness which is awareness of what is going on inside of them and with their disorder. An increase in control can help decrease dominating alters (Allers, C.T., ; Golson, J., 1994). It is proven that a combination of this treatment and professional support and help shows improvements and decreased hospitalization (Brand, B. L., Loewenstein, R. J., ; Spiegel, D. (2014).
When a patient is being treated, timing is an important aspect. If a patient has not come to terms with what has happened in their past, it is possible that they will be retraumatized if they are prompted to face their past prematurely (Chu, J. A., 1994). Often times while being treated, their therapists learn and become familiar with all the identities well enough that the therapist can actually treat each identity as their own and switch up techniques as different identities surface instead of treating one person with a divided sense of their self (Chu, J. A., 1994).
Allers, C. T., ; Golson, J. (1994). Multiple personality disorder: Treatment from an Adlerian perspective. Individual Psychology: The Journal Of Adlerian Theory, Research ; Practice, 50(3), 262.
Aquarone, R., Goodwin, M., ; Richardson, S. (2017). Holding the parts as one. Therapy Today, 28(10), 26-29.
Brand, B. L., Loewenstein, R. J., ; Spiegel, D. (2014). Dispelling Myths About Dissociative Identity Disorder Treatment: An Empirically Based Approach. Psychiatry: Interpersonal ; Biological Processes, 77(2), 169-189. doi:10.1521/psyc.2014.77.2.169
Chu, J. A. (1994). The rational treatment of multiple personality disorder. Psychotherapy: Theory, Research, Practice, Training, 31(1), 94-100. doi:10.1037/0033-3126.96.36.199
Dunn, G. E. (1992). Multiple personality disorder: A new challenge for psychology. Professional Psychology: Research And Practice, 23(1), 18-23. doi:10.1037/0735-7028.23.1.18
Fox, J. j., Bell, H., Jacobson, L., ; Hundley, G. (2013). Recovering Identity: A Qualitative Investigation of a Survivor of Dissociative Identity Disorder. Journal Of Mental Health Counseling, 35(4), 324-341.
Hooley, J. M., Butcher, J. N., Nock, M., ; Mineka, S. (2017). Abnormal psychology.