Download Dissociative identity disorder [Not to be confused with Dissocial

Dissociative identity disorder [Not to be confused with Dissocial personality disorder]
Split personality" redirects here. For other uses, see Split personality (disambiguation).
Dissociative identity disorder is a psychiatric diagnosis and describes a condition in which a person
displays multiple distinct identities or personalities (known as alter egos or alters), each with its own
pattern of perceiving and interacting with the environment.
In the International Statistical Classification of Diseases and Related Health Problems the name for this
diagnosis is multiple personality disorder. In both systems of terminology, the diagnosis requires that at
least two personalities routinely take control of the individual's behavior with an associated memory
loss that goes beyond normal forgetfulness; in addition, symptoms cannot be the temporary effects of
drug use or a general medical condition.[1] DID is less common than other dissociative disorders,
occurring in approximately 1% of dissociative cases,[2] and is often comorbid with other disorders.[3]
There is a great deal of controversy surrounding the topic of DID. The validity of DID as a medical
diagnosis has been questioned, and some researchers have suggested that DID may exist primarily as an
iatrogenic adverse effect of therapy.[4][5][6][7][8] DID is diagnosed significantly more frequently in
North America than in the rest of the world.[9][10]
Signs and symptoms
Individuals diagnosed with DID demonstrate a variety of symptoms with wide fluctuations across time;
functioning can vary from severe impairment in daily functioning to normal or high abilities. Symptoms
can include:
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Multiple mannerisms, attitudes and beliefs which are not similar to each other
Unexplainable headaches and other body pains
Distortion or loss of subjective time
Depersonalization
Derealization
Severe memory loss
Depression
Flashbacks of abuse/trauma
Sudden anger without a justified cause
Frequent panic/anxiety attacks
Unexplainable phobias
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Auditory of the personalities inside their mind
Paranoia
Patients may experience an extremely broad array of other symptoms that may appear to resemble
epilepsy, schizophrenia, anxiety disorders, mood disorders, post traumatic stress disorder, personality
disorders, and eating disorders.[11]
Physiological findings
Reviews of the literature have discussed the findings of various psychophysiological investigations of
DID.[12][13] Many of the investigations include testing and observation in the one person but with
different alters. Different alter states have shown distinct physiological markers[14] and some EEG
studies have shown distinct differences between alters in some subjects,[15][16] while other subjects'
patterns were consistent across alters.[17]
Neuroimaging studies of individuals with dissociative disorders have found higher than normal levels of
memory encoding and a smaller than normal parietal lobe.[18]
Another study concluded that the differences involved intensity of concentration, mood changes,
degree of muscle tension, and duration of recording, rather than some inherent difference between the
brains of people diagnosed with DID.[19] Brain imaging studies have corroborated the transitions of
identity in some DID sufferers.[20] A link between epilepsy and DID has been postulated but this is
disputed.[21][22] Some brain imaging studies have shown differing cerebral blood flow with different
alters,[23][24][25] and distinct differences overall between subjects with DID and a healthy control
group.[26]
A different imaging study showed that findings of smaller hippocampal volumes in patients with a
history of exposure to traumatic stress and an accompanying stress-related psychiatric disorder were
also demonstrated in DID.[27] This study also found smaller amygdala volumes. Studies have
demonstrated various changes in visual parameters between alters.[28][29][30] One twin study showed
hereditable factors were present in DID.[31]
Causes
This disorder is theoretically linked with the interaction of overwhelming stress, traumatic
antecedents,[32] insufficient childhood nurturing, and an innate ability to dissociate memories or
experiences from consciousness.[11] A high percentage of patients report child abuse.[7][33] People
diagnosed with DID often report that they have experienced severe physical and sexual abuse, especially
during early to mid childhood.[34] Several psychiatric rating scales of DID sufferers suggested that DID is
strongly related to childhood trauma rather than to an underlying electrophysiological dysfunction.[35]
Others believe that the symptoms of DID are created iatrogenically by therapists using certain treatment
techniques with suggestible patients,[4][6][7][8] but this idea is not universally
accepted.[33][36][37][38][39][40] Skeptics have observed that a small number of US therapists were
responsible for diagnosing the majority of individuals with DID there, that patients did not report sexual
abuse or manifest alters until after treatment had begun, and that the "alters" tended to be rulegoverned social roles rather than separate personalities.[8]
Development theory
It has been theorized that severe sexual, physical, or psychological trauma in childhood predisposes an
individual to the development of DID. The steps in the development of a dissociative identity are
theorized to be as follows:
1. The child is harmed by a trusted caregiver (often a parent or guardian) and splits off the
awareness and memory of the traumatic event to survive in the relationship.
2. The memories and feelings go into the subconscious and are experienced later in the form of a
separate personality.
3. The process happens repeatedly at different times so that different personalities develop,
containing different memories and performing different functions that are helpful or
destructive.
4. Dissociation becomes a coping mechanism for the individual when faced with further stressful
situations.[41]
Diagnosis
The diagnosis of Dissociative identity disorder is defined by criteria in the American Psychiatric
Association's Diagnostic and Statistical Manual of Mental Disorders (DSM). The DSM-II used the term
multiple personality disorder, the DSM-III grouped the diagnosis with the other four major dissociative
disorders, and the DSM-IV-TR categorizes it as dissociative identity disorder. The ICD-10 continues to list
the condition as multiple personality disorder.
The diagnostic criteria in section 300.14 (dissociative disorders) of the DSM-IV require that an adult, for
non-physiological reasons, be recurrently controlled by multiple discrete identity or personality states
while also suffering extensive memory lapses.[42] While otherwise similar, the diagnostic criteria for
children requires also ruling out fantasy.
Diagnosis should be performed by a psychiatrist or psychologist who may use specially designed
interviews (such as the SCID-D) and personality assessment tools to evaluate a person for a dissociative
disorder.[1]
The psychiatric history of individuals diagnosed with DID frequently contain multiple previous diagnoses
of various mental disorders and treatment failures.
The proposed diagnostic criteria for DID in the DSM-5 is:[43]
1. Disruption of identity characterized by two or more distinct personality states or an experience
of possession, as evidenced by discontinuities in sense of self, cognition, behavior, affect,
perceptions, and/or memories. This disruption may be observed by others, or reported by the
patient.
2. Inability to recall important personal information, for everyday events or traumatic events, that
is inconsistent with ordinary forgetfulness.
3. Causes clinically significant distress and impairment in social, occupational, or other important
areas of functioning.
4. The disturbance is not a normal part of a broadly accepted cultural or religious practice and 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).
NOTE: In children, the symptoms are not attributable to imaginary playmates or other fantasy
play.
Treatment
Treatment of DID may attempt to reconnect the identities of disparate alters into a single
functioning identity. In addition or instead, treatment may focus on symptoms, to relieve the
distressing aspects of the condition and ensure the safety of the individual. Treatment methods may
include psychotherapy and medications for comorbid disorders.[1] Some behavior therapists initially
use behavioral treatments such as only responding to a single identity, and using more traditional
therapy once a consistent response is established.[52] It has been stated that treatment
recommendations that follow from models that do not believe in the traumatic origins of DID might
be harmful due to the fact that they ignore the posttraumatic symptomatology of people with
DID.[38]