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Dissociative Identity Disorder (DID)

Dissociative Identity Disorder (DID), previously known as Multiple Personality Disorder (MPD) and other Dissociative Disorders have caused much controversy in the medical community, especially with the advent of books and movies about people with repressed or forgotten memories of childhood abuse and multiple personalities numbering 10 or more. These disorders are now commonly recognized as the effects of severe trauma in early childhood, typically extreme, repeated physical, sexual or emotional abuse. Though some doctors feel that caution is required to avoid ‘leading’ the patient to remember things that did not happen, or to ‘create’ alternate identities, in all but the most extreme and unusual cases neither of these concerns apply. Mild dissociation is like daydreaming, or getting lost in a good book, or driving down a familiar stretch of road and finding that you’ve forgotten the last few miles of the drive. Severe and chronic dissociation differs from what most of us experience in these examples. Dissociative Identity Disorder, previously called Multiple Personality Disorder, and other Dissociative Disorders result in broken connections between thoughts, memories and sense of identity. Other dissociative disorders include psychogenic amnesia where the patient is unable to recall personally significant memories, psychogenic fugue with memory loss characteristic of amnesia, loss of identity, and fleeing home environment, and Dissociative Identity Disorder, where the patient appears to have two or more distinct, alternating personalities. Dissociation is typically a psychological defense mechanism that has psychobiological.phpects. Research seems to illustrate that this process is initially used to deflect traumatic experiences and allow the patient to handle trauma, and that it evolves over time into a pathological process. The disorders most often occur in childhood, when a child is subjected to trauma. Children who learn to disassociate to endure extended abuse will often use this coping mechanism in response to any stress they endure during their adult life. On rare occasions, adults may develop dissociative disorders because of severe trauma.

What are the symptoms?

• Fugue states, sleepwalking, and automatic writing
• Shifting moods, fears, abilities, anxieties, preferences, inconsistent knowledge
• Auditory hallucinations
• Sense of detachment from self and feeling that the world is unreal or distorted
• Identity confusion
• Headaches, amnesia, time loss, trance like state, mood swings, sleep disorders,
• Child seems withdrawn, frightened or uninvolved in environment
• Problems in school, truancy, running away, delinquency
• Depression, anxiety, difficulty trusting others, hostility as adults
• Two or more ‘personalities’ with only one of the personalities present at any given moment, and one of them dominant most of the time. Personalities are discrepant and seem to be opposite, original personality has no knowledge of the other(s). When a personality is interacting with the environment, other personalities may not know what is happening. Each personality has unique memories, behavior patterns, and relationships. Transition from one personality to another is sudden, and usually in response to stress.

How is it diagnosed and treated?

The primary problem in diagnosing DID is the confusion regarding dissociative disorders and the effects of psychological trauma, and misconception about the clinical.phpects of the diagnosis. DID is relatively common but patients may minimize or conceal symptoms, or symptoms can be coincident with post-traumatic stress disorder, depression, panic, and eating disorders and therefore the doctor may miss the signs of DID. The American Psychiatric Association defines the diagnostic criteria for DID, as follows:

• The presence of two or more distinct identities or personality states (each with its own relatively enduring pattern of perceiving, relating to, and thinking about the environment and self).
• Inability to recall important personal information that is too extensive to be explained by ordinary forgetfulness.
• At least two of these identities or personality states recurrently take control of the person's behavior.
• The disturbance is not due to the direct physiological effects of a substance (e.g., blackouts or chaotic behavior during Alcohol Intoxication) or a general medical condition (e.g., complex partial seizures). In children, the symptoms are not attributable to imaginary playmates or other fantasy play.

Treatment(s) can include:

• Psychotherapy
• Hypnotherapy or Pentothal, if appropriate to recover memories
• Eye Movement Desensitization and Reprocessing (EMDR) if appropriate
• Cognitive Behavioral Therapy
• Hospitalization in severe cases
• Medication as appropriate: antidepressants, anti-anxiety medication
• Specially designed questionnaire tools to identify specific symptoms for treatment
• Meditation, Imagery

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