Me, Myself and I: A Look into the Dissociative Identity Disorder
Dissociative disorders and specifically the Dissociative Identity Disorder are most often associated with an impact to the patient’s identity and personality because of a traumatic event or a series of repeated trauma over time, causing changes in personality or even development of new personalities. About 2% of adults experience DID, with women being more likely than men to report an episode.
DID can be considered an involuntary escape from reality and can be interpreted as an “emergency defense,” or a “shut off mechanism”, protecting their owner from further upset and trauma. In the simplest term, in the face of overwhelming stress, the individual cannot allow themselves to be fully consciously present for the experiences nor can they control what is happening and so a protective layer forms in their consciousness and dissociation is born. There is also typically a loss of needed data to help understand what took place and proceed with the plan for recovery and stabilization.
The functions that are characteristically impaired by the trauma and lead to the DID are consciousness, memory, identity sense and perception, There are well-documented cases of DID (more commonly known as Multiple Personality Disorder, and the 10 Most Famous Cases of this illness can be found here: http://listverse.com/2015/03/16/10-famous-cases-of-dissociative-identity-disorder/
Due to the sensational nature of this condition and the inability to confirm the veracity of the symptoms, DID has received notoriety in pop culture (most recently in the movie “Split”). There are several questions and controversies surrounding this disorder as well – for example the fact that it appears to be a cultural phenomenon predominantly in North America (Myrick, 2015). Questions arose whether the disorder is popularized by the culture and the media such as the movies and whether people maintaining they have multiple personalities are simply looking for a way to avoid responsibility for some of their behaviors. The disorder became, in a way, glamorized as a way to cope with stressful situations – but no real determinant as to what degree of stress could cause this response, nor a way to test for validity.
Since some of the symptoms of the disorders include developing several identities or personalities most psychiatrists agree that this is a defense mechanism to help cope with the aftermath of the trauma, most prescribed treatments are aimed at assisting the patient in being able to exist within the identities successfully, including such concepts as principles of stabilization, skill-focused symptom management, and stabilization specific to multiple disorders (Welzant, 2005).
Diagnosing the DID could be challenging in the past due to lack of understanding of the workings of the disorder and the disbelief of the general concept of multiple identities. Gentile et al describe the symptoms that are used to diagnose the DID in their 2013 article. One of the requisites for the diagnosis is that the patient must exhibit two or more distinct identities or personality states.
At least two of these identities or personality states would also recurrently take control of the person’s behavior. Important and critical portions of time or information may be lost and irrecoverable and such loss of data is not attributed to an external source such as a blackout due to alcohol, for instance. In children, these symptoms must not be attributable to imaginary playmates or the like (Gentile, 24). They also suggest that a diagnosis should not be made until a treating psychiatrist can observe the dissociation happen or a change from one personality to the other or others is made.
A resultative approach to treating DID may be a three-phase treatment plan. In the first phase, the emphasis is on symptom stabilization and safety of the patient, addressing any potential for self-harm and through corroboration helping the patient move toward impulse regulation as well as toward internal communication with themselves around the fact that self-injurious behaviors are attempts to reenact the traumatic event (2012). The second phase then allows the patient to explore the actual events and memories as well as any cognitive distortions or loss of information related to the events. This phase allows the patient to reclaim some of the memories, take mastery over their narratives and develop a new sense of self and purpose. Phase three invites the patient to reconnect all the selves and “fuse” them together so no dissociation occurs and the selves function as a system (Brand et al, 2012). immersive therapy such as suggested previously may be more harmful to the patient than it is healing due to the potential of further traumatizing the patient by revisiting the causes of the disorder and discussing adaptive and cognitive strategies across the personalities. They explore the alternatives of not treating the disorder and addressing only the symptoms or the comorbidities, Their conclusion is that the types of treatment that do not address DID symptoms, specifically those of amnesia and identity alteration, does not appear to improve the recurrences of the disorder (Brand, 2014).
Psychopharmacology is not recommended as the sole treatment and is typically reserved to treat the co-morbid disorders such as depression, or the bipolar disorder. Loewenstein in his 2005 research indicates that DID often presents with such co-morbid disrupted functionalities as eating disorders, poor body image, sleep disorders, anxiety, lack of attention to medical needs, and self-harming or self-destructive behaviors (666). The author suggests that any prescribed psychopharmacology must be assessed in the contest of the overall and total treatment of the patient and must attempt to treat the symptoms that are present across most of the personalities or alters (Loewenstein, 2005). With these caveats, the researchers agree that the psychopharmacology in DID can make a real difference in ameliorating the most severe and debilitating symptoms of both the disorder and its accompanying comorbidities.
Brand, B. L., Myrick, A. C., Loewenstein, R. J., Classen, C. C., Lanius, R., McNary, S. W., Putnam, F. W. (2012). A survey of practices and recommended treatment interventions among expert therapists treating patients with dissociative identity disorder and dissociative disorder not otherwise specified. Psychological Trauma: Theory, Research, Practice, and Policy, 4(5), 490-500. Retrieved from https://search.proquest.com/docview/909287536?accountid=166133
Brand, B., Loewenstein, R., Spiegel, D. (2014). Dispelling Myths About Dissociative Identity Disorder Treatment: An Empirically Based Approach. Psychiatry 77(2), 169-189.
Butcher, J. N., Hooley, J. M., & Mineka, S. (2014). Abnormal psychology (16th ed.). Boston, MA: Pearson.
Gentile, J. P., Dillon, K. S., & Gillig, P. M. (2013). Psychotherapy and Pharmacotherapy for Patients with Dissociative Identity Disorder. Innovations In Clinical Neuroscience, 10(2), 22-29.
Loewenstein, R. (2005). Psychopharmacologic Treatments for Dissociative Identity Disorder. Psychiatric Annals, 35 (8), 666-673.
Myrick, A. C., Chasson, G. S., Lanius, R. A., Leventhal, B., & Brand, B. L. (2015). Treatment of complex dissociative disorders: a comparison of interventions reported by community therapists versus those recommended by experts. Journal Of Trauma & Dissociation: The Official Journal Of The International Society For The Study Of Dissociation (ISSD), 16(1), 51-67. doi:10.1080/15299732.2014.949020
Welzant, V. (2005). Stabilizing patients with dissociative disorders. Psychiatric Annals, 35(8), 678-684. Retrieved from https://search.proquest.com/docview/621153137?accountid=166133