Download Dissociative Identity Disorder

Presented by : Shahdan Al Dabbass
Dissociation: the separation of thoughts,
feelings or experiences from the normal
stream of consciousness and
memory.
IN Dissociative Disorder Severe isolated
traumas or repeated traumas may result in
impairment of the normal state of awareness
or alters one’s sense of identity, memory or
consciousness.
Dissociative disorders are prevalent around the
world and often occur with other psychiatric
disorders such as depression, post traumatic
stress disorder, substance use disorders and
borderline personality.
Dissociative disorders includes:
 Dissociative amnesia +/- Dissociative fugue
 Dissociative identity disorder
 Depersonalization/ derealization disorder
Inability to recall important personal
information usually of a traumatic or stressful
condition that is too extensive to be explained
by normal forgetfulness.
Epidemiology
approximately 6% of the general population.
Reported in late adolescence and adulthood..
Women > men .
Increase incidence during times of war and
natural disasters.
One or more episodes of inability to recall
personal information.
 Disturbance doesn’t occur exclusively during
any other dissociative disorder and not due to
direct effects of a substance or GMC.
 Symptoms cause clinically significant distress
or impaired social, occupational .. Etc
functioning.

◦ Localized amnesia: Inability to recall events related
to a limited period of time.
◦ Selective amnesia: Ability to remember some, but
not all, of the events occurring during a
circumscribed period of time.
◦ Systematized amnesia: Amnesia for certain
categories of memory, such as all memories
relating to one's family or to a particular person
◦ Generalized amnesia: Failure to recall one's entire
life.
◦ Continuous amnesia: Failure to recall successive
events as they occur.
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Ordinary Forgetfulness and Non pathological
Amnesia
Dementia, Delirium, and Organic Amnestic
Disorders
Posttraumatic Amnesia
Seizure Disorders
Substance-Related Amnesia
Transient Global Amnesia
Acute Stress Disorder, Posttraumatic Stress
Disorder, and Somatoform Disorders
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Acute dissociative amnesia frequently
spontaneously resolves once the person is
removed to safety from traumatic or
overwhelming circumstances.
some patients do develop chronic forms of
generalized, continuous, or severe localized
amnesia.
Recurrences are uncommon
I.
II.
III.
It is important to help patients retrieve their
lost memories in order to prevent future
recurrences.
Hypnosis or pharmacologically facilitated
interviews by sodium amobarbital, thiopental
(Pentothal) to help patients talk freely.
Psychotherapy
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dissociative fugue is now a specifier of
dissociative amnesia rather than a separate
diagnosis (DSM V)
Sudden, unexpected travel with inability to
recall one’s past
Assume new identity
May involve new name, job, personality
characteristics
 More often of brief duration
Remits spontaneously

Sudden unexpected travel away from home or
ones customary place of work, with inability
to recall one’s past.
 Confusion about personal identity or
assumes new identity (partial or complete)
 Not due to another dissociative disorder or
direct effects of substances or GMC
 Causes significant distress or impairment in
imp areas of functioning
Epidemiology
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Rare
Predisposing factors include heavy use of alcohol,
major depression, history of head trauma and
epilepsy.
Course and Prognosis
It usually lasts for few hours to several days but may
last longer.
Treatment
Similar as dissociative amnesia
formerly

multiple personality disorder (MPD)
Two or more distinct personalities that take control
of an individuals behavior
inability to recall key personal information that is too
far-reaching to be explained as mere forgetfulness.
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The different identities (alters) may exhibit
differences in :
1) speech ,mannerisms , attitudes, thoughts and
gender orientations etc
2) in “physical” properties such as allergies , rightor-left handedness
1.3 % prevalence ( avg age 30 yrs)
 male :female 1.3:9
 history of a sexual or a physical abuse
Over 70% of outpatients with dissociative identity
disorder have attempted suicide
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Causes
( no one knows the exact root cause of “DID” but those have
been the most researched )
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Repeated episodes of severe physical or sexual
abuse in childhood
Innate ability to dissociate easily
Extreme stress
Other relatives with dissociative symptoms or
disorders
A. Disruption of identity characterized by two or more distinct personality states, which
may be described in some cultures as an experience of possession. The disruption in
identity involves marked discontinuity in sense of self and sense of agency, accompanied
by related alterations in affect, behavior, consciousness, memory, perception,
cognition, and/or sensory-motor functioning. These signs and symptoms may be
Observed by others or reported by the individual.
B. Recurrent gaps in the recall of everyday events, important personal information, and/
or traumatic events that are inconsistent with ordinary forgetting.
C. The symptoms cause clinically significant distress or impairment in social, occupational, or
other important areas of functioning.
D. The disturbance is not a normal part of a broadly accepted cultural or religious practice.
Note: In children, the symptoms are not better explained by imaginary playmates or other
fantasy play.
E. The symptoms are not attributable to the physiological effects of a substance (e.g.,
blackouts or chaotic behavior during alcohol intoxication) or another medical condition
 Usually
chronic and incomplete
recovery
 Worst prognosis of all dissociative
disorders
 Patients with earlier onset have a
poorer prognosis
Feeling like more than one person
 Being called names that are unlike their name
 Having blackouts  not recalling how one traveled
to a certain area
 Not recognizing themselves in the mirror
 Finding items that are clearly theirs but not
recalling how the items were acquired
Comorbid disorders : PTSD, depressive disorders, 
trauma- and stressor-related disorders,
personality disorders, conversion disorder.
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The goal
:
to integrate the personalities into a single
personality
OR
To achieve a harmonious interaction among the
personalities that allows more normal
functioning
1) psychotherapy with hypnosis ; the therapist
seeks to make contact with as many alters as
possible to understand their roles and
functions in the patient’s life
2) drug therapy ; relieve some specific coexisting
symptoms ( anxiety and depression )
3) Several periods of psychiatric hospitalization
maybe necessary to help the patient through
difficult time
4) Mutual self-help support groups within larger
communities
Depersonalization disorder is characterized by
persistent or recurrent feeling of detachment
from one’s self, environment or social
situations .
They are aware of their symptoms and often
fear they are going crazy .
Often accompanied by anxiety or panic.
A. The presence of persistent or recurrent experiences of depersonalization,
derealization, or both:
1. Depersonalization: Experiences of unreality, detachment, or being an outside
observer with respect to one’s thoughts, feelings, sensations, body, or actions (e.g.,
perceptual alterations, distorted sense of time, unreal or absent self, emotional and/or
physical numbing).
2. Derealization: Experiences of unreality or detachment with respect to surroundings
(e.g., individuals or objects are experienced as unreal, dreamlike, foggy, lifeless, or
visually distorted).
B. During the depersonalization or derealization experiences, reality testing remains
intact.
C. The symptoms cause clinically significant distress or impairment in social,occupational,
or other important areas of functioning.
D. The disturbance is not attributable to the physiological effects of a substance (e.g., a
drug of abuse, medication) or another medical condition (e.g., seizures).
E. The disturbance is not better explained by another mental disorder
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The gender ratio for the disorder is 1:1
Average onset between ages 15 and 30
Increased incidence of co-morbid anxiety
disorders and major depression
Severe stress is a predisposing factor
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Course and prognosis
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Often chronic , but may remit without treatment
Treatment
The goal of treatment, when needed, is to
address all stresses associated with the onset
of the disorder.
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Psychotherapy : Cognitive therapy, Family
therapy, Clinical hypnosis, Creative therapies
Antianxiety agents or SSRI to treat associated
symptoms of anxiety and major depression
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