Dissociative Identity Disorder

Dissociative Identity Disorder, formerly known as Multiple Personality Disorder, is a complex psychological condition that is characterized by the presence of two or more distinct personality states or identities within a single individual. These different identities may have their own names, ages, histories, and mannerisms. A central aspect of the disorder is a disconnection between thoughts, identity, consciousness, and memory. The disorder often arises as a response to trauma, serving as a coping mechanism to isolate and compartmentalize traumatic experiences. The exact prevalence of DID is difficult to determine, but it is estimated that it affects about 1% of the global population. This disorder is more frequently diagnosed in females than males, which may be due to differences in how men and women respond to and report trauma and symptoms. The causes of DID are not entirely understood but are strongly linked to severe and prolonged trauma experienced during early childhood, usually extreme, repetitive physical, sexual, or emotional abuse. Genetics and personal dispositions may also play a role, making certain individuals more susceptible to developing the disorder following trauma. Symptoms of DID can be varied and may include memory loss (amnesia) of certain time periods, events, and people; mental health problems such as depression, anxiety, and suicidal thoughts and behaviours; a sense of being detached from oneself; and the perception of the people and things around oneself as distorted and unreal. Treatment for DID typically involves psychotherapy with a clinician skilled in treating dissociation. The aim is to integrate the separate identities into one primary identity and to address the traumatic memories that underlie the fragmentation of the identity. There is no definitive cure, and treatment can be long-term and complex. Medication may be used to address symptoms of co-occurring disorders, such as depression or anxiety, but there is no specific pharmacological treatment for DID itself. Understanding and treating DID is challenging due to its complexity and the need for individualized treatment plans. Nevertheless, with appropriate therapy, individuals with DID can achieve stability, decrease dissociative episodes, and improve their functioning in daily life.

If you suspect you or someone else is experiencing Dissociative Identity Disorder, it is crucial to seek immediate medical attention by calling emergency services or consult with a Psychologist.

Causes

The development of Dissociative Identity Disorder (DID) is believed to be a complex interplay between severe trauma and a person’s individual capacity to dissociate. Dissociation is a mechanism where a person mentally separates themselves from a part of their life or identity, and in the case of DID, it is often in response to extreme stress or trauma. The predominant hypothesis is that DID is a reaction to extreme stress during critical periods of development in childhood, particularly when physical, sexual, or emotional abuse is involved. The repeated, overwhelming stress prompts the child to detach from the reality of the abuse as a form of psychological escape. Each identity may then serve a unique role in helping the individual cope with life's circumstances, with some identities holding memories of trauma and others functioning in daily life. In a broader context, other factors such as the ability to dissociate easily, suggestibility, and lack of a supportive or comforting environment after trauma may also contribute to the development of DID. The disorder likely represents a failure to integrate various aspects of identity, memory, and consciousness in a multi-dimensional response to trauma.

Risk Factors

The main risk factor for DID is experiencing severe, repetitive trauma in early childhood. The type, severity, and duration of the trauma, and the age at which it occurred, are critical factors. The following are risk factors for the development of DID: 1. Chronic Trauma: Sustained physical, sexual, or emotional abuse, especially in childhood. 2. Early Age of Trauma Onset: The younger the child during the onset of the trauma, the greater the risk of developing DID, as the identity is less integrated in early life. 3. Absence of Safe Attachments: Lack of a supportive or comforting figure to provide validation and care after traumatic events can increase risk. 4. Inherent Ability to Dissociate: Individuals vary in their natural ability to dissociate; those who dissociate easily are more at risk. 5. Other Mental Health Disorders: Pre-existing mental health conditions or the presence of dissociative disorders in close family members may be associated with an increased risk of developing DID. The risk of complications from DID includes the possibility of self-harm, suicidal ideation and attempts, severe disruptions in social and occupational functioning, and vulnerability to further trauma or revictimization. Additionally, there is a high prevalence of comorbid conditions such as depression, anxiety disorders, eating disorders, and substance abuse, which can further complicate both diagnosis and treatment.

Symptoms

The symptoms of DID can be extensive and variable but are often characterized by the following: • Multiple Identities: The existence of two or more distinct identity states, each with its own enduring pattern of perceiving, relating to, and thinking about the environment and self. • Amnesia: Gaps in memory for personal history, including sometimes significant life events, like forgetting one’s own wedding or not recognizing a spouse. • Time Loss: Periods in which time has passed but the person cannot recall what has occurred. These are often times when another identity has taken control. • Depersonalization: Feeling detached from one’s own body or emotions, like being an outside observer of themselves. • Derealization: Experiencing the world as unreal, dreamlike, or distorted. • Identity Confusion or Alteration: A sense of confusion about who one is, or feeling like there are distinct parts of the identity that may conflict. • Somatic Symptoms: Physical symptoms without a clear physical cause, which might include non-epileptic seizures or sensory distortions. • Distress and Impairment: The symptoms cause significant distress or problems in social, occupational, or other important areas of functioning. In some individuals, the transitions between identities can be observable by others and may be abrupt. The different identities may have their own age, sex, or race. Each identity may also have its own postures, gestures, and distinct ways of talking. Sometimes the changes are more subtle. Individuals with DID may also experience intense headaches or other physical pains and symptoms when one identity transitions to another. These symptoms of DID can disrupt cognitive function and the ability to function in various settings, and the distress from these symptoms can further compound other mental health issues. Understanding these symptoms is critical for healthcare professionals when diagnosing and treating DID.

Diagnosis

Diagnosis of Dissociative Identity Disorder (DID) can be challenging, primarily due to the complexity of the disorder and the presence of symptoms that can overlap with other psychiatric conditions. The process includes the following steps: 1. Clinical Assessment: A detailed interview with a mental health professional is central to the diagnosis of DID. This assessment will include a comprehensive discussion of symptoms, personal history, and the presence of dissociative episodes. 2. Use of Diagnostic Manuals: Clinicians refer to criteria listed in the Diagnostic and Statistical Manual of Mental Disorders, 5th Edition (DSM-5) to diagnose DID. The criteria include the presence of two or more distinct identities or personality states, amnesia, and the disturbance not being a part of a broadly accepted cultural or religious practice. 3. Dissociative Tests: Structured clinical interviews like the Dissociative Experiences Scale (DES) or the Structured Clinical Interview for Dissociative Disorders (SCID-D) may be used. 4. Rule Out Other Conditions: It’s important to differentiate DID from other psychiatric disorders, such as bipolar disorder, schizophrenia, or borderline personality disorder. Therefore, a careful evaluation to rule out these conditions is necessary. 5. Assessment of Comorbid Disorders: Many individuals with DID also have comorbid disorders such as PTSD, depression, or substance use disorders. Diagnosing these conditions is part of the assessment process. 6. Physical Examination: Though there are no physical tests that can diagnose DID, a physical exam and sometimes neurological tests can help rule out physical illness or medication side effects that might mimic DID. 7. Longitudinal Observation: Sometimes, healthcare providers may need to observe a patient’s symptoms over time to understand the range of dissociation and to confirm the diagnosis of DID.

Treatments

Treatment of DID is typically long-term and focuses on reintegration of identity and coping with trauma. Common treatment modalities include: 1. Psychotherapy: This is the primary treatment for DID and is often long-term. Therapists work with patients to understand the cause of their dissociation and to unify the different identities. 2. Cognitive-Behavioural Therapy (CBT): CBT is adapted to help patients challenge and change unhelpful beliefs and behaviours associated with each identity and to improve coping with trauma. 3. Dialectical Behaviour Therapy (DBT): DBT may be used to treat individuals with DID who experience intense emotional disturbances, providing them with skills to manage mood swings and reduce self-destructive behaviours. 4. Eye Movement Desensitization and Reprocessing (EMDR): EMDR is another therapy designed to alleviate the distress associated with traumatic memories, potentially assisting in the integration of identities. 5. Family Therapy: This therapy can be beneficial in educating family members about the disorder and helping them provide support. 6. Creative Therapies: Art or movement therapy can provide individuals a way to express their thoughts and feelings in a safe, creative way. 7. Medication: No medication is currently approved to treat DID directly, but antidepressants, anxiolytics, or antipsychotic medications may be prescribed to help control symptoms associated with comorbid disorders. 8. Inpatient Care: In cases of severe distress or when there is a risk of harm to self or others, hospitalization may be necessary.

Preventive Measures

There are no sure ways to prevent DID as the factors leading to its development are not entirely understood or avoidable. However, some strategies may help mitigate the risks: 1. Early Intervention: Addressing trauma promptly and effectively may prevent the development of severe dissociation that can lead to DID. 2. Trauma-Informed Care: For children especially, interventions by child protective services and trauma-informed therapeutic approaches can provide the support needed to prevent the development of severe dissociative symptoms. 3. Supportive Care: Providing a supportive environment for those who have experienced trauma can help mitigate dissociative responses. 4. Psychoeducation: Educating those at risk, such as individuals with a family history of dissociative disorders, about the signs and symptoms can lead to earlier detection and intervention. 5. Monitoring At-Risk Populations: Children known to be in abusive situations should be closely monitored by social services and mental health professionals to intervene as necessary. 6. Building Resilience: Programs aimed at building resilience in children, teaching coping skills, and providing social support may help children cope with adversity without developing dissociative strategies. Given that DID is a response to overwhelming stress, strategies to reduce the incidence of child abuse and domestic violence, improve parenting skills, and support at-risk families are essential to reducing the incidence of this and other trauma-related conditions.

Do's & Don’t's

If you suspect you or someone else is experiencing Dissociative Identity Disorder, it is crucial to seek immediate medical attention by calling emergency services or consult with a Psychologist.