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All about: Dissociative Identity Disorder

Dissociative Identity Disorder (DID) is defined as a person showing two or more different personalities which are referred to as alternate personalities (alters), each exhibiting different memories, behaviors, thoughts, and emotions (Comer & Comer, 2021).

In the Diagnostic and Statistical Manual of Mental Disorders - 5 (DSM-V), DID is one of three named dissociative disorders, the other two being Dissociative Amnesia and Depersonalization/Derealization Disorder. To be diagnosed as someone with a dissociative identity disorder, a person must show a disruption of identity with two or more distinct personality states. This means that these personalities should be inhibit the person to be aware of their “original self” by affecting their behavior, consciousness, memory, perception, and sensory-motor functioning. This is evident when the person shows gaps in their memory of everyday events, important personal information and/or traumatic events. A note to be made, this is different from ordinary forgetting and should not be treated as such. The person should exhibit significant distress and impairment in social, occupational, and other important areas of social functioning. These disturbances are also not the cause of common religious practices or under the influence of any substance such as alcohol or drugs.


Characteristics of DID

Individuals with DID usually have one primary personality, called the host personality, who reaches out for help due to becoming overwhelmed from holding all the personalities. Several patients have an impulsive personality that is responsible for their sexual drives and often associates it with making money by becoming a prostitute. There can exist cross-gendered alters as well where a weak fragile woman can switch into a male character that has a deeper voice and acts as a protector. When an individual changes from one alter ego to another, it is referred to as a switch and it can happen instantaneously.


Causes of DID

Studies have shown that one major cause of dissociative identity disorder is childhood trauma. Putnam et al (1986) reported that of 100 cases, 97% experienced severe sexual or physical abuse. Abuse can range from being buried alive, torture with matches, razors, blades, etc. It makes sense that an individual who is very young is experiencing some form of abuse, they might not be aware that this is considered abuse and refrain from reporting it to the authorities, or otherwise too scared to report it. To escape such a negative situation, individuals therefore dissociate to another character that can offer them comfort and strength to deal with this type of situation. The brain as a result learns to develop such personalities in time of need that can offer the individual protection from such a situation. In literature, it has been found that DID shares many characteristics with Post Traumatic Stress Disorder (PTSD) and researchers claim that DID is a more severe subtype of PTSD with an emphasis on dissociation rather than anxiety (Butler et al., 1996). Some researchers also claim that the development of DID can happen up till 9 years of age and after that if the individual experiences abuse, it will just develop into PTSD.


Treatment of DID

Treatment of Dissociative Identity Disorder has proven to be complicated as compared to treatments for other dissociative disorders. This is because the aim of the treatment is to reintegrate multiple personalities into one. This has been proven somewhat successful through long-term psychotherapy (Brand et al., 2009). The most important goal of the therapy is to identify the triggers that may provoke memories of trauma, dissociation and to neutralize them. The patient must confront their past trauma, and through the help of the therapist, visualize and relive aspects of the trauma until it just becomes a terrible memory instead of current event. One should be wary that bringing up discussions of past trauma in a clinical setting might cause further dissociation to occur. The therapist should obtain trust and try to discourage dissociation as much as possible. (Barlow et al., 2018).


References

Comer, R. J., & Comer, J. S. (2021). Abnormal psychology (international edition). Worth Publishers, Incorporated.


American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders (5th ed.).

https://doi.org/10.1176/appi.books.9780890425596


Putnam, F. W., Guroff, J. J., Silberman, E. K., Barban, L., & Post, R. M. (1986). The clinical phenomenology of multiple personality disorder: Review of 100 recent cases. Journal of Clinical Psychiatry, 47, 285-293.


Butler, L. D., Duran, R. E. F., Jasiukaitis, P., Koopman, C., & Spiegal, D. (1996). Hypnotizability and traumatic experience: A diathesis stress model of dissociative symptomology. American Journal of Psychiatry, 153, 42-63.


Brand, B., Classen, C., Lanins, R., Loewenstein, R., McNary, S., Pain, C., & Putnam, F. (2009). A naturalistic study of dissociative identity disorder and dissociative disorder not otherwise specified patients treated by community clinicians. Psychological Trauma: Theory, Research, Practice, and Policy, 1(2), 153-171.


Barlow, D. H., Durand, V. M., & Hofmann, S. G. (2018). Abnormal Psychology: An Integrative Approach. Cengage Learning.




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