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Formerly known as multiple personality disorder, dissociative identity disorder (DID) is a condition in which a person has more than one distinct identity or personality condition. At least two of these personalities repeatedly claim that they control the person's behavior. Each personality state has a unique name, background, identity, and self-image.
Psychiatrists and psychologists use a manual calledDiagnostic and Statistical Manual of the Psyche unrest, revision of the text of the fourth edition resp.DSM-IV-TRto diagnose mental disorders. In this guide, DID is classified as a dissociative disorder. Other mental disorders in this category include depersonalization disorder , dissociative fugue , mi dissociative amnesia . However, it should be noted that the nature of DID and even its existence is the subject of debate among psychiatrists and psychologists.
“Dissociation” describes a state in which the integrated functioning of a person's identity, including awareness, memory, and perception of the environment, is disrupted or eliminated. Dissociation is a mechanism that allows the mind to separate or compartmentalize specific memories or thoughts from normal consciousness. These memories are not erased but buried and may resurface at a later date. Dissociation is related to hypnosis, since the hypnotic trance also involves a temporarily altered state of consciousness. Dissociation occurs along a continuum or spectrum and can be mild and within the range of normal experience, or it can be severe and problematic for the person experiencing the dissociation. An example of easy and everyday dissociation is when a person drives on the highway for a long time, making several exits without remembering. With severe and disabling dissociation, an individual experiences a lack of awareness of important aspects of their identity.
The phrase "dissociative identity disorder" has replaced "multiple personality disorder" because the new name emphasizes the disruption in a person's identity that characterizes the disorder. A person with the condition is aware of one aspect of his or her personality, while being totally unaware or dissociated from other aspects of it. This is a key feature of the disorder. It only takes two different identities or personality states to qualify as DID, but there have been cases where 100 different alternate personalities or alters have been reported. Fifty percent of DID patients have fewer than 11 identities.
As the personalities take turns controlling the patient's consciousness and behavior, the affected patient experiences long memory gaps, gaps that go far beyond the typical forgetful episodes experienced by people without DID.
Despite the existence of different personalities, in many cases there is a primary identity. He uses the name the patient was born with and tends to be quiet, dependent, depressed and guilty. Personalities have their own unique names and traits. They are characterized by different temperaments, likes, dislikes, expressions, and even physical characteristics like posture and body language. It is not uncommon for DID patients to have individuals of different genders, sexual orientations, ages, or nationalities. It usually only takes a few seconds for one personality to replace another, but in rarer cases the change can be gradual. In both cases, the rise of one personality and the decline of another are usually caused by a stressful event.
People with DID tend to have other serious disorders as well, such as depression, substance abuse, Borderline personality disorder and eating disorders, among others. The degree of impairment varies from mild to severe, and complications can arise. Suicide Attempted self-harm, violence, or drug abuse.
If left untreated, DID can last a lifetime. Treatment of the disorder consists mainly of psychotherapy .
causes and symptoms
The severe dissociation that characterizes patients with DID today is due to several causes:
- an innate ability to easily dissociate
- repeated severe physical or sexual episodes Abuse in the childhood
- Lack of a support or comfort person to neutralize abusive family members
- Influence of other family members with dissociative symptoms or disorders
The main cause of DID appears to be severe and persistent trauma experienced during childhood. This trauma may be associated with emotional, physical, or sexual abuse, or a combination of these. One theory is that young children, when faced with routine torture, sexual abuse, or negligence , distancing themselves from their trauma by creating separate identities or personality states. A manufactured personality can suffer when the primary identity "escapes" from the unbearable experience. Dissociation, which is easy for a small child, thus becomes a useful defense. This strategy transfers suffering to another identity. Over time, the child, who is an average of six years old at the time of the appearance of the first altar, can create many more.
As mentioned above, there is considerable controversy about the nature and even the existence of dissociative identity disorder. One reason for skepticism is the alarming increase in reports of the disease since the 1980s. One area of controversy is the notion of repressed memories, a critical component in DID. Many memory research experts say it's nearly impossible to remember things that happened before the age of three, the age at which some DID patients have been abused, but storage, retrieval, and interpretation of those memories has not yet been achieved. childhood memories in the brain they fully understand each other. The relationship between dissociative disorders and childhood maltreatment has generated much controversy and lament over the accuracy of childhood memories. Since childhood trauma is a factor in the development of DID, some doctors believe that it may be a variation of DID. post traumatic stress disorder (PTSD). In both DID and PTSD, dissociation is a prominent mechanism.
The main dissociative symptoms in patients with DID are: amnesia , depersonalization , derealization and identity disorders.
AMNESIA.Amnesia in DID is characterized by gaps in the patient's memory for long periods of their past and, in some cases, during their childhood. Most DID patients have amnesia, or "lost time," during periods when another personality is "out." They may report finding items in your home that they don't remember buying, finding notes with a different handwriting, or finding other evidence of unexplained activity.
DEPERSONALIZATION.Depersonalization is a dissociative symptom in which the patient feels that their body is unreal, changes, or dissolves. Some DID patients experience depersonalization as a feeling of being out of body or watching a movie of themselves.
DEREALIZATION.Derealization is a dissociative symptom in which the patient perceives the external environment as unreal. Patients may see walls, buildings, or other objects that change shape, size, or color. DID patients are unable to recognize family members or close friends.
IDENTITY DISORDERS.People with DID often have a main personality, which psychiatrists call a "host." Usually this is not the person's original personality, but one developed in response to childhood trauma. It is usually this personality that seeks psychiatric help. DID patients often fear their dissociative experiences, which can include losing consciousness for hours or even days, meeting people who claim to know them by a different name, or feeling "out of body."
Psychiatrists refer to the transition phase between different personalities as "alternation." After one turn, people adopt completely new postures, voices, and vocabulary. Special circumstances or stressful situations can create special identities. Some patients have irregular school history or job performance caused by alternating personalities during exams or other stressful situations. Each alternate identity takes control sequentially and denies control to the others. Patients differ from each other in their awareness of their personalities. A personality cannot acknowledge the existence of others or criticize other personalities. Sometimes during therapy, one alter may allow another to take over.
Studies in North America and Europe show that up to 5% of patients on psychiatric wards have undiagnosed DID. Partially hospitalized and outpatients may have an even higher incidence. For every man diagnosed with DID, there are eight or nine women. In children, boys and girls diagnosed with DID are matched almost exactly 1:1. No one is quite sure why this discrepancy exists between diagnosed adults and children.
DieDSM-IV-TRlists four diagnostic criteria to identify DID and distinguish it from similar disorders:
- Traumatic Stressor: The patient has been exposed to a catastrophic event involving actual or threatened death or injury, or a serious physical threat to self or others. During trauma exposure, the person's emotional response was characterized by intense fear, feelings of helplessness, or horror. In general, intentionally man-made stressors (genocide, rape, torture, abuse, etc.) are experienced as more traumatic than accidents, natural disasters, or "acts of God."
- Evidence of two or more distinct identities or personality states in an individual. Each separate identity must have its own way of thinking, perceiving, relating and interacting with the environment and with itself.
- Two of the identities take control of the patient's behavior, one at a time and repeatedly.
- Prolonged periods of forgetfulness that last too long to be considered common forgetfulness.
- Determine that the above symptoms are not due to drugs, alcohol or other substances and are not due to another general medical condition. It is also necessary to exclude make-believe games or imaginary friends when considering a To diagnose of DID in a child.
Correctly diagnosing DID is complicated because some of the symptoms of DID overlap with the symptoms of other mental disorders. Misdiagnoses are common and include depression, schizophrenia , Borderline personality disorder, somatization disorder , mi PANIC syndrome .
Because the extreme dissociative experiences associated with this disorder can be frightening, people with this disorder may go to emergency rooms or clinics for fear of losing their minds.
When a physician examines a patient for DID, they first rule out physical conditions that sometimes produce amnesia, depersonalization, or derealization. These conditions include head injuries, Brain Illness (especially seizure disorders), medication side effects, substance abuse or poisoning, AIDS craziness complex or recent periods of extreme physical exertion to emphasize and insomnia. In some cases, doctors may perform an electroencephalogram (EEG) on the patient to rule out epilepsy or other seizure disorders. The doctor should also check that the patient is simulate and/or offer fictitious claims.
If the patient appears physically healthy, the doctor rules out psychotic disorders, including schizophrenia. Many DID patients are misdiagnosed as schizophrenic because they can "talk" their personalities in their heads. If your doctor suspects DID, he or she may use a screening test called the Dissociative Experience Scale (DES). If the patient scores high on this test, they can be further assessed using the Dissociative Disorders Interview Plan (DDIS) or the Structured Clinical Interview for Dissociative Disorders (SCID-D).
Treatment for DID in adults can take five to seven years and typically requires several different treatment modalities.
Ideally, patients with DID should be treated by a therapist with special training in dissociation. This specialized training is important because the patient's personality changes can be confusing or surprising. In addition, many DID patients have hostile or suicidal old-age personalities. Most therapists who treat patients with DID have treatment policies or contracts that address issues such as the patient's responsibility for their safety. Psychotherapy for patients with DID usually has several phases: an initial phase to discover and "map" the patient's personality; a phase of treatment of traumatic memories and "fusion" of personalities; and a period of consolidation of the patient's newly integrated personality.
Most therapists treating multiples or DID patients recommend further treatment after personality integration because the patient has not learned the social skills that most people acquire in adolescence and early adulthood. Also, family therapy it is often recommended to help the patient's family understand DID and the changes that occur during personality reintegration.
Many DID patients are helped group therapy and individual treatments if the group is limited to people with dissociative disorders. DID patients sometimes have setbacks in mixed therapy groups because other patients are upset or frightened by their personality changes.
Some doctors prescribe sedatives or antidepressants to DID patients because their altered personalities may be suffering from anxiety or mood disorders. However, other therapists treating DID patients prefer to keep medications to a minimum because these patients can easily become psychologically dependent on the medications. In addition, many DID patients are at least one age and abuse drugs or alcohol, substances that are dangerous when combined with most sedatives.
While not always necessary, hypnosis (or hypnotherapy ) is a standard treatment method for patients with DID. Hypnosis can help patients recover repressed ideas and memories. In addition, hypnosis can also be used to control problem behaviors that many DID patients exhibit, such as B. Self-harm or eating disorders. bulimia . In the later stages of treatment, the therapist may use hypnosis to "fuse" the personalities as part of the process of integrating the patient's personality.
Unfortunately, there are currently no systematic studies on the long-term course of DID. Some therapists believe that the prognosis for cure is excellent for children and good for most adults. Although treatment lasts several years, it is often effective. In general, the earlier the patient is diagnosed and properly treated, the better the prognosis. Patients may notice that the symptoms bother them less in middle age, with some relief starting in their 40s. However, stress or substance abuse can cause symptoms to return at any time.
The prevention of DID requires intervention in abusive families and treat children with dissociative symptoms as soon as possible.
see also Dissociation and dissociative disorders
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Rebecca J. Frey, Ph.D.
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