Survey
* Your assessment is very important for improving the workof artificial intelligence, which forms the content of this project
* Your assessment is very important for improving the workof artificial intelligence, which forms the content of this project
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: 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 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]